title: Racial differences in incident de novo donor-specific anti-HLA antibody among primary renal allograft recipients: results from a single center cohort study.
abstract: Controversy exists as to whether African American (AA) transplant recipients are at risk for developing de novo donor-specific anti-human leucocyte antigen (HLA) antibody (dnDSA). We studied 341 HLA-mismatched, primary renal allograft recipients who were consecutively transplanted between 3/1999 and 12/2010. Sera were collected sequentially pre- and post-transplant and tested for anti-HLA immunoglobulin G (IgG) via single antigen bead assay. Of the 341 transplant patients (225 AA and 116 non-AA), 107 developed dnDSA at a median of 9.2 months post-transplant. AA patients had a 5-year dnDSA incidence of 35%. This was significantly higher than the 5-year dnDSA incidence for non-AA patients (21%). DQ mismatch (risk) and receiving a living-related donor (LRD) transplant (protective) were transplant factors associated with dnDSA. Within the AA patient cohort, HLA-DQ mismatch, not-receiving a LRD transplant, nonadherence and BK viraemia were the most common factors associated with early dnDSA (occurring <24 months post-transplant). Nonadherence and pretransplant diabetes history were the strong precursors to late dnDSA. Despite the higher rates of dnDSA in the AA cohort, post-dnDSA survival was the same in AA and non-AA patients. This study suggests that DQ matching, increasing LRD transplantation in AA patients and minimizing under-immunosuppression will be key to preventing dnDSA.
authors.affiliation: Terasaki Foundation Laboratory, Los Angeles, CA, USA.
authors.forename: Matthew J
authors.identifier: http://orcid.org/0000-0001-7392-5483
authors.initials: MJ
authors.lastname: Everly
authors.affiliation: Department of Pathology, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
authors.forename: Kimberly P
authors.initials: KP
authors.lastname: Briley
authors.affiliation: Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
authors.forename: Carl E
authors.initials: CE
authors.lastname: Haisch
authors.affiliation: Terasaki Foundation Laboratory, Los Angeles, CA, USA.
authors.forename: Georg
authors.initials: G
authors.lastname: Dieplinger
authors.affiliation: Department of Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Bolin
authors.affiliation: Eastern Nephrology Associates, Greenville, NC, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Kendrick
authors.affiliation: Department of Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
authors.forename: Claire
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Vidant Medical Center, Greenville, NC, USA.
authors.forename: Angela Q
authors.initials: AQ
authors.lastname: Maldonado
authors.affiliation: Department of Pathology, Brody School of Medicine at East Carolina University, Greenville, NC, USA.
authors.forename: Lorita M
authors.initials: LM
authors.lastname: Rebellato
mesh_terms: D000328:Adult; D001741:Black or African American; D000918:Antibody Specificity; D001739:BK Virus; D015331:Cohort Studies; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000276:immunology; D006680:HLA Antigens / Q000276:immunology; D006683:HLA-DQ Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007518:Isoantibodies / Q000097:blood*; D016030:Kidney Transplantation / Q000009:adverse effects; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D027601:Polyomavirus Infections / Q000209:etiology; D044469:Racial Groups; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D014412:Tumor Virus Infections / Q000209:etiology; D014766:Viremia / Q000209:etiology; D044465:White People
chemical_list: D006680:HLA Antigens; D006683:HLA-DQ Antigens; D007074:Immunoglobulin G; D007518:Isoantibodies
keywords: alloantibodies; epidemiology; race; transplantation