Racial differences in incident de novo donor‐specific anti‐HLA antibody among primary renal allograft recipients: results from a single center cohort study

Summary 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