title: Disparate rates of acute rejection and donor-specific antibodies among high-immunologic risk renal transplant subgroups receiving antithymocyte globulin induction.
abstract: Lymphocyte-depleting induction lowers acute rejection (AR) rates among high-immunologic risk (HIR) renal transplant recipients, including African Americans (AAs), retransplants, and the sensitized. It is unclear whether different HIR subgroups experience similarly low rates of AR. We aimed to describe the incidence of AR and de novo donor-specific antibody (dnDSA) among HIR recipients categorized by age, race, or donor type. All received antithymocyte globulin (ATG) induction and triple maintenance immunosuppression. A total of 464 HIR recipients from 2007 to 2014 were reviewed. AR and dnDSA rates at 1 year for the entire population were 14% and 27%, respectively. AR ranged from 6.7% among living donor (LD) recipients to 30% in younger AA deceased donor (DD) recipients. De novo donor-specific antibody at 1 year ranged from 7% in older non-AA LD recipients to 32% in AAs. AA race remained as an independent risk factor for AR among DD recipients and for dnDSA among all HIR recipients. Development of both AR and dnDSA within the first year was associated with a 54% graft survival at 5 years and was an independent risk factor for graft loss. Despite utilization of recommended immunosuppression for HIR recipients, substantial disparities exist among subgroups, warranting further consideration of individualized immunosuppression in certain HIR subgroups.
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA.
authors.forename: Samir J
authors.initials: SJ
authors.lastname: Patel
authors.affiliation: Department of Medicine, Houston Methodist Hospital, Houston, TX, USA.
authors.forename: Wadi N
authors.initials: WN
authors.lastname: Suki
authors.affiliation: Department of Pharmacy, Kansas University Medical Center, Kansas City, KS, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Loucks-DeVos
authors.affiliation: Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Graviss
authors.affiliation: Houston Methodist Research Institute, Houston Methodist Hospital, Houston, TX, USA.
authors.forename: Duc T
authors.initials: DT
authors.lastname: Nguyen
authors.affiliation: Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Knight
authors.affiliation: Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA.
authors.forename: Samantha A
authors.initials: SA
authors.lastname: Kuten
authors.affiliation: Department of Pharmacy, Kansas University Medical Center, Kansas City, KS, USA.
authors.forename: Linda W
authors.initials: LW
authors.lastname: Moore
authors.affiliation: Department of State Health Services, Houston, TX, USA.
authors.forename: Larry D
authors.initials: LD
authors.lastname: Teeter
authors.affiliation: Department of Pathology, Houston Methodist Hospital, Houston, TX, USA.
authors.forename: Lillian W
authors.initials: LW
authors.lastname: Gaber
authors.affiliation: Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.
authors.forename: A Osama
authors.initials: AO
authors.lastname: Gaber
mesh_terms: D000328:Adult; D001741:Black or African American; D000906:Antibodies / Q000276:immunology; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D005260:Female; D006084:Graft Rejection / Q000276:immunology*; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000208:ethnology; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000906:Antibodies; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents
keywords: HLA-antibody post-transplantation; Immunosuppression; antilymphocyte globulin; rejection