Aim: African American (AA) patients who receive Caucasian (CA) liver allografts have an increased risk of death compared to AA patients who receive AA liver allografts. We hypothesized that this difference could be explained by HLA donor specific alloantibodies (DSA) instead of the allograft race. Methods: Since 1985, our biorepository prospectively collects protocol serum samples from all donors and recipients of liver transplantation (LT) in conjunction with a clinical and laboratory research database. We analyzed all 804 adult recipients of a primary LT without another organ from 1/00 to 5/09 with a pre-LT sample available (96% of the total) for analysis of DSA whose donor and recipient race were either CA or AA. 88% also had a post-LT sample tested for DSA. All patients had their serum blinded and analyzed with LABScreen^TM single antigen beads. 90% of patients were CA, 80% received a CA graft and 20% received an AA graft. 10% were AA, 79% received a CA graft and 21% received an AA graft. DSA with an MFI >5000 was considered positive. Results: AA patients had inferior survival if they received a CA graft instead of an AA graft (p=0.01). AAs were found to have inferior survival with either preformed class I or class II DSA vs. their Caucasian counterparts with preformed class I or II DSA (Figure). In addition, AA patients who received CA grafts who had class II DSA (pre- or post-LT) experienced inferior survival compared to those without class II DSA (p = 0.05). Fortunately, AA patients without DSA had outcomes similar to CA patients, regardless of the race of their graft. In conclusion, AAs with preformed HLA DSA have an increased risk of death after LT compared to CAs with preformed HLA DSA. Fortunately, AA patients transplanted without DSA, regardless of the race of their donor, had equivalent outcomes to Caucasian patients.

Terasaki, P.: Stockholder, One Lambda, Chairman.

« Back to 2013 American Transplant Congress