*Purpose: African American (AA) kidney transplant (KTx) candidates are disadvantaged given increased immunologic risk and longer waitlist time. The purpose of this study was to compare 1-year outcomes of AA with panel reactive antibody ≥30% (HPRA) who received post-operative plasmapheresis (PP) after KTx vs. those with PRA <30% (LPRA).

*Methods: This was a retrospective cohort study of AA KTx recipients between 1/1/2015-12/31/2018. Patients with ABO-incompatibility or positive T and/or B cell crossmatch were excluded. All patients received lymphocyte depleting induction along with tacrolimus, mycophenolate, and early corticosteroid withdrawal. HPRA patients received PP on post-operative days 1, 3, and 5. Primary outcome was allograft function at 1-year. Secondary outcomes included incidence of rejection, infection, and patient and allograft survival.

*Results: A total of 197 AA KTx recipients were analyzed. Baseline characteristics are outlined in Table 1. HPRA group had a significantly different indication for KTx, a higher number of female patients, median peak class I PRA of 63.5% (0-100%) and class II PRA of 73.0% (0-100%). Clinical outcomes are described in Table 2. Although HPRA group experienced more rejection [17 (43.6)% vs. 36 (22.8)%, p=0.008], there was no difference in 1-year allograft function, allograft failure, patient mortality, incidence of CMV or BK viremia between the groups.

*Conclusions: AA KTx recipients with HPRA who receive post-operative PP achieve similar allograft function compared to LPRA KTx recipients. Although, 1-year clinical outcomes are favorable, long-term follow up is warranted.

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