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Racial Disparity In Antibody Mediated Rejection In Renal Transplantation
*Colleen McDermott1, *Katie Carsky1, *David Chernobylsky1, *Peter Ferrin1, *India Gaines1, *Anil Paramesh1, *Rubin Zhang1, *Geoffrey Parker2, *Michael Darden3, Joseph F Buell4
1Tulane University, New Orleans, LA;2ThayerSchool of Engineering Dartmoth College, Hannover, NH;3Carey School of Business, Johns Hopkins University, Baltimore, MD;4Mission Health, Univeristy of North Carolina Asheville, Asheville, NC

Introduction: A higher incidence of rejection and graft loss is experienced by African American (AA) patients that has historically been attributed to more frequent and aggressive rejections in this patient population. Little data currently exists on the existence of racial disparity in antibody mediated rejection in this population.
Methods: Analysis of rejection risk and graft failure was performed using multiple logistic regressions of 859 renal transplant recipients from '06-17 to assess relative risk (RR) and Kaplan-Meier (KM) graft survival after T-cell (TC), and antibody mediated rejections (AMR).
Results: The median interval to rejection event from transplant was shorter in AA (7.0 vs. 9.0 mos; p=0.045) and for TC versus AMR rejections (11.6 vs 16.6 mos; p=0.045). Regression analysis identified younger age, AA race, non-alemtuzumab induction and neupogen administration as independent risks for rejection. In rejection subtype analysis, the relative risk (RR) associated with AA race was highest in AMR. Despite racial disparity in incidence and time to occurrence, no difference in KM graft survival was identified between races (HR 1.18; p=0.481), rejection type (AMR: HR 0.76; p=0.332) nor time to AMR (>1 year: HR 1.70; p=0.371).
Conclusions: African American race appears to be associated with a higher incidence of rejection and especially antibody mediated rejection. However, our study identified that under current modern immunosuppressive protocols specifically alemtuzumab induction there was no higher risk of graft loss by race, time to AMR nor subtype of rejection.
CohortRejection CohortOdds RatioP value
Age49.446.20.980.006
AfricanAmerican537 (62%)175 (74%)2.050.001
Alemtuzumab288 (33%)74 (31%)0.410.009
Neupogen121 (14%)57 (24%)3.260.001
AMR Cohort(n=65)
Age49.442.60.970.006
Male Gender505 (58%)45 (70%)2.080.018
Neupogen121 (14%)23 (35%)2.600.002
AfricanAmerican537 (62%)53 (83%)3.500.002


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