TIME COURSE AND RATES OF REJECTION IN ATSI RENAL TRANSPLANT RECIPIENTS

R SWAMINATHAN1, S BURROWS2, A IRISH1

1Department of Nephrology &Renal transplantation, Fiona Stanley Hospital, Perth; 2University of Western Australia

Background: Despite a significantly increased burden of ESRD, ATSI patients are less likely to be transplanted and have inferior transplant-related outcomes to non- ATSI patients.

Aim:  A comparison of the rates and time course of BPAR in ATSI and Non-ATSI patients in WA

Methods A retrospective review of consecutive transplants over a 5 year period in 56 Aboriginal (ATSI – Aboriginal and Torres State Islander) and 84 Non- Aboriginal (Non-ATSI) deceased donor renal transplant recipients (RTRs) in Western Australia (WA).

Results: ATSI recipients were more likely from remote areas, had more diabetes (prevalent and incident), waited longer and received less well matched grafts but immunosuppression burden were similar to Non-ATSI patients. The BPAR rates were similar in both groups, [32/56 (57.1%) of ATSI had an episode of BPAR compared with 34/84 (40.5 %) of non- a ATSI RTRs P=0.4.] The severity of rejection was also similar between the 2 groups (Data not shown). However, the median time to first BPAR was significantly delayed, 144 (95% CI 42,592) days in the ATSI compared with 39 (4,104) days in the non- ATSI. (p=0.01).  The odds of BPAR occurring after 1 year post transplant was 4.0 (95 % CI -1.2, 13.1) in the ATSI compared with Non ATSI (p=0.02)

Conclusions: Rates of BPAR did not differ between ATSI and NON-ATSI however significant proportion of BPAR occurred after the 1st year post transplantation in ATSI. Medication non- adherence, reduced clinical oversight and inter-current illness may contribute however further studies are warranted.

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