519.4 Non-Immunologic Pairing of Kidney Transplant Donors and Recipients: How Important is HLA Match Status? Amanda Miller, Bryce Kiberd, Karthik Tennankore Department of Medicine, Division of Nephrology, Dalhousie University, Halifax, NS, Canada. Currently, allocation preference in deceased donor kidney transplanta- tion is given to donors and recipients (D/R) with 0 human leukocyte anti- gen (HLA) mismatches (MM), with non-immunologic matching between D/R rarely considered. Thus, the primary aim for this study was to deter- mine if suboptimal pairing at five D/R loci (age, race, sex, weight and CMV serostatus) results in an increased risk of kidney graft failure, how this impact relates to HLA MM, and if HLA MM modifies this effect. The association of D/R match with death-censored graft loss was ex- plored using deceased donor recipients from 2000-2014 identified through the Scientific Registry of Transplants Recipients. A Cox regres- sion coefficient-based scoring system was used to assign points to each D/R pairing. Points were totaled across all five D/R loci and overall match was categorized as favorable (<0), moderate (0 to < 8), or poor (≥8), with cut points chosen to create relatively even tertiles. D/R match groups were stratified by HLA match (favorable (0MM) or poor (1-6MM)). Time to graft loss was evaluated using multivariable Cox Proportional Hazards models adjusting for known literature predictors of graft loss. The interac- tion between HLA MM and D/R pairing was assessed to determine if HLA MM modifies the association between D/R pairing and graft outcome. 17,786 of 107,041 kidney transplant recipients developed death- censored graft failure. D/R matching was a stronger predictor of graft fail- ure than HLA MM. The highest HRs for graft failure were observed for poorly matched D/R, irrespective of HLA MM (HR 3.50 95% CI [3.18-3.85]; HR 2.73 95% CI [2.40-3.11] for poor and favorably matched HLA, re- spectively). Even with suboptimal HLA match, the risk of graft loss was mitigated for those with a favorable D/R match (HR 1.51 95% CI [1.37- 1.66]). Both D/R match and HLA MM were independently associated with the outcome of interest and and the interaction between D/R match and HLA MM was significant. In conclusion, non-immunologic D/R matching is a stronger predictor of death-censored graft failure than is HLA match status. HLA MM mod- ifies this association. 519.5 Success of a “Multicultural Donation Education Program” to Increase African-American Organ Donation in a Donor Service area with a High African-American Population Ruth Duncan Bell 1 , Bobby Howard 2 , Paula Lawrence 1 , Kathleen Lilly 2 , Marty Sellers 1 , Jean Davis 1 1 LifeLink Foundation, Tampa, FL, United States; 2 LifeLink of Georgia, Norcross, GA, United States. Introduction: Our donor service area (DSA) has a population over 10 million with a greater than two-fold proportion of African-Americans (AA) compared to the rest of the United States (31% vs. 13%). It was apparent in the 1990s that transplant programs in our DSA had an even higher disproportionate number of AA on organ waiting lists; in contrast, we had a disproportionately low number of AA donors. Efforts to decrease this disparity were desperately needed. We aimed to address this by the creation of a “Multicultural Donation Education Pro- gram” (MDEP) in 1994. We report the success of this ongoing program. Methods: MDEP began in 1994; quality improvement was driven by frequent evaluations based on donation data and stakeholder feedback; it evolved and refocused accordingly. Various staffing and general public educational prac- tices were implemented over 4 time periods – e.g., racial sensitivity training, “like-race” donation requestors, focused media campaigns and public service announcements on public transit and in predominately AA churches, busi- nesses, schools/colleges, professional associations, and communities; in- creased emphasis during Black History Month; AA transplant recipient participation in outreach. A detailed timeline is shown in Figure 1. Donor demographics over these periods were recorded in a prospective database and compared to national (OPTN) data. Additionally, in the 4th time period (2013-16) a survey inside and in multiple states outside our DSA was performed to see if there was increased willingness to be an organ donor among AA in our DSA. Results: The AA population in our DSA increased during the study period from 27% to 31%; the proportion of AA donors increased from 21% to 33% (15/ 70 vs. 102/306). Our proportion of AA donors has exceeded that in our general FIGURE 1. FIGURE 1. © 2018 Wolters Kluwer Abstracts S289 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.