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Racial differences in incident de novo donor-specific anti-HLA antibody among primary renal allograft recipients: results from a single center cohort study.
Transpl Int. 2017 Jun; 30(6):566-578.TI

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+Show Affiliations

Terasaki Foundation Laboratory, Los Angeles, CA, USA.Department of Pathology, Brody School of Medicine at East Carolina University, Greenville, NC, USA.Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, NC, USA.Terasaki Foundation Laboratory, Los Angeles, CA, USA.Department of Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.Eastern Nephrology Associates, Greenville, NC, USA.Department of Medicine, Brody School of Medicine at East Carolina University, Greenville, NC, USA.Vidant Medical Center, Greenville, NC, USA.Department of Pathology, Brody School of Medicine at East Carolina University, Greenville, NC, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28211192

Citation

Everly, Matthew J., et al. "Racial Differences in Incident De Novo Donor-specific anti-HLA Antibody Among Primary Renal Allograft Recipients: Results From a Single Center Cohort Study." Transplant International : Official Journal of the European Society for Organ Transplantation, vol. 30, no. 6, 2017, pp. 566-578.
Everly MJ, Briley KP, Haisch CE, et al. Racial differences in incident de novo donor-specific anti-HLA antibody among primary renal allograft recipients: results from a single center cohort study. Transpl Int. 2017;30(6):566-578.
Everly, M. J., Briley, K. P., Haisch, C. E., Dieplinger, G., Bolin, P., Kendrick, S. A., Morgan, C., Maldonado, A. Q., & Rebellato, L. M. (2017). Racial differences in incident de novo donor-specific anti-HLA antibody among primary renal allograft recipients: results from a single center cohort study. Transplant International : Official Journal of the European Society for Organ Transplantation, 30(6), 566-578. https://doi.org/10.1111/tri.12937
Everly MJ, et al. Racial Differences in Incident De Novo Donor-specific anti-HLA Antibody Among Primary Renal Allograft Recipients: Results From a Single Center Cohort Study. Transpl Int. 2017;30(6):566-578. PubMed PMID: 28211192.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Racial differences in incident de novo donor-specific anti-HLA antibody among primary renal allograft recipients: results from a single center cohort study. AU - Everly,Matthew J, AU - Briley,Kimberly P, AU - Haisch,Carl E, AU - Dieplinger,Georg, AU - Bolin,Paul, AU - Kendrick,Scott A, AU - Morgan,Claire, AU - Maldonado,Angela Q, AU - Rebellato,Lorita M, Y1 - 2017/03/21/ PY - 2016/10/16/received PY - 2016/11/14/revised PY - 2017/02/13/accepted PY - 2017/2/18/pubmed PY - 2018/6/5/medline PY - 2017/2/18/entrez KW - alloantibodies KW - epidemiology KW - race KW - transplantation SP - 566 EP - 578 JF - Transplant international : official journal of the European Society for Organ Transplantation JO - Transpl. Int. VL - 30 IS - 6 N2 - 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. SN - 1432-2277 UR - https://www.unboundmedicine.com/medline/citation/28211192/Racial_differences_in_incident_de_novo_donor_specific_anti_HLA_antibody_among_primary_renal_allograft_recipients:_results_from_a_single_center_cohort_study_ L2 - https://doi.org/10.1111/tri.12937 DB - PRIME DP - Unbound Medicine ER -