SIGNIFICANT DIFFERENCES IN THE EFFICACY OF KIDNEY TRANSPLANTATION BETWEEN HUNGARIAN CAUCASIANS AND GYPSIES.

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P330 Aims: A recent study revealed that the Gypsy ethnic group living in Hungary has different HLA phenotypes. The most significant difference found in the Gypsy population was the frequency of the HLA A1,B17,DR3 and HLA A19,B27,DR2 haplotypes (11.5% and 5.4%), which are 60 and 50 times more frequent than in any other population represented in the Bone Marrow Donor Worldwide Registry. In contrast, the most frequent HLA A1,B8,DR3 haplotype in the Hungarian Caucasians is missing by the Gypsies. Methods: In a retrospective study we sought to examine whether there were differences between Caucasian (Group A) and Gypsy (Group B) renal allograft recipients transplanted in Hungary. Results: From 1983 to 2001 1,918 transplants were performed at our transplant center (1,825 Caucasian and 93 Gypsy recipients). Group B patients were younger (34 +/- 12 vs 42 +/- 14 years of age, p<0.01) and Group A had more polycystic kidney disease (12 % vs 3%, p<0.025). Blood group B was apparently more common in Group B (27% vs 19%, NS) than Group A and Group A had seemingly more diabetes (5% vs 1%, NS) than Group B. There were no differences in donor-recipient HLA mismatches or pre-transplant panel reactive antibodies. There were no differences in Group A vs Group B patient survivals at 1, 3, 5, or 10 years post-transplant (98% vs 95%, 90% vs 93%, 85% vs 88% and 74% vs 82%, respectively). However, Group A graft survivals were significantly better than Group B at 1, 3, 5 and 10 years post-transplant (89% vs 77%, 82% vs 66%, 76% vs 54% and 57% vs 34%, each comparison p<0.01). Group B recipients experienced a greater number of acute rejection episodes (66% vs 49% p<0.01), irreversible acute rejections (15% vs 6%, p<0.001), chronic rejections(34% vs 18%, p<0.001) and graft loss due to immunosuppression non-compliance (5% vs 1%, p<0.05) than Group A recipients. Conclusions: As has been previously described for other non-Caucasian ethnic groups (African Americans), Hungarian Gypsies appear to be at a greater immunological risk for rejection and poorer long term graft survival. Improvement could possibly be achieved by the promotion of the living related donation and by individualized immunosuppression. Moreover, sophisticated genetic investigations are needed to clarify the possible factors responsible for transplantation hyperreactivity and their relation to the MHC.