INCIDENCE, TYPES AND PREDICTORS OF ACUTE REJECTION IN INDIGENOUS KIDNEY TRANSPLANT RECIPIENTS IN WESTERN AUSTRALIA

P HOWSON1, A IRISH2, G PERRY3, A SHARMA4, G WONG4, WH LIM1

1Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth; 2Department of Renal Medicine, Fiona Stanley Hospital, Perth; 3Department of Nephrology and Transplantation, Royal Perth Hospital, Perth; 4Centre for Kidney Research & Department of Renal Medicine, Westmead Hospital, Sydney.

Aim: We aimed to examine the incidence, risk factors and patterns of acute rejection in indigenous kidney transplant recipients in Western Australia (WA).

Background: Indigenous kidney transplant recipients have a greater risk of premature allograft loss and mortality after kidney transplantation compared to indigenous recipients, but the incidence and patterns of acute rejection are not well described.   

Methods: Indigenous end-stage kidney disease patients who have received a kidney transplant between 2000-2010 in WA were included. Patient-level data were extracted from local databases to determine the incidence and patterns of acute rejection. Predictors of rejection were examined using a logistic regression model.

Results: Of 642 patients who have received a kidney transplant in WA, 60 (9%) were indigenous patients. During the study period, 23% were highly-sensitised (panel reactive antibody >50%) and 68% had received kidneys with 4-6 HLA-mismatches (vs. 12% and 35% for non-indigenous patients during the same time-period, p<0.001). In the indigenous cohort during a median (IQR) patient follow-up time of 7.9 (5.7) years, 43 (72%) experienced rejection, with 21 (35%) experiencing multiple rejections. Of those who had experienced rejections, 43 (100%), 13 (30%) and 24 (56%) were cellular, vascular and antibody-mediated rejections (AMR), respectively. HLA-mismatches were associated with AMR with adjusted odds ratio (OR) of 1.68 (95%CI 1.11-2.54, p=0.01) for every HLA-mismatch. There was no association with vascular rejection (adjusted OR 1.28, 95%CI 0.82-2.02).

Conclusions: Almost three-quarters of indigenous kidney transplant recipients experienced acute rejection after transplantation, with over 50% of rejections attributed to AMR. HLA-mismatches is a risk factor for developing AMR and allocation policies aim to reduce the number of HLA-mismatches could potentially improve transplant outcome.

About ANZSN

The ASM is hosted by Australian and New Zealand Society of Nephrology.

The aims of the Society are to promote and support the study of the kidney and urinary tract in health and disease, and to ensure the highest professional standards for the practice of nephrology in Australia and New Zealand.

Conference Managers

Please contact the team at Conference Design with any questions regarding the Annual Scientific Meeting

/wp-content/uploads/2017/08/Conference-Design-400×400.png

© 2015 - 2016 Conference Design Pty Ltd