Allograft Injury and Outcomes in African American Lung Transplant Recipients

Purpose African American patients (AA) have poorer outcomes than White patients (W) after heart and kidney transplant. Little is known about differential outcomes in lung transplantation (LTx). This study compares allograft injury and chronic allograft dysfunction (CLAD) in AA and W LTx. Methods The 469 LTx enrolled in two multicenter prospective cohort studies were categorized by self-reported race. Outcomes: Time from transplant to CLAD-free survival adjudicated by a committee using ISHLT standard definitions. Measure: Serial post-transplant plasma samples (n=2152) were assayed for %ddcfDNA by shotgun sequencing. Analyses : Baseline characteristics, post-transplant %ddcfDNA trends, tacrolimus trough levels and CLAD-free survival were compared between AA and W. Results LTx recipients were 79% W and 14 % AA. Donor-recipient race mismatch was more commonly observed for AA than for W (75.0% vs. 27.3%, p Conclusion AA LTx show higher allograft injury and poorer CLAD-free survival than W LTx despite equivalent tacrolimus blood levels. Studies to understand the mechanisms of allograft injury and poor outcomes in AA are warranted across all solid organ transplants.