A2 to B Kidney Transplantation in the Post-Kidney Allocation System Era: A 3-year Experience with Anti-A Titers, Outcomes, and Cost

Impact of the 2014 kidney allocation system changes on trends in A2/A2B into B kidney transplantation and organ procurement organization reporting of donor subtyping

“…The practice of using A2/A2B blood type kidneys as donor organs for blood type B recipients is now well established, and results in graft survival outcomes comparable to blood type matched donors. 9,10 Sufficient time has elapsed since the introduction of the KAS system in December 2014 to permit meaningful comparisons of case volumes pre-and post-implementation, and our aim was to describe these practice patterns at the transplant center level. We found that indeed, implementation of the KAS resulted in an increase in the breadth of this practice in that post-KAS there were nearly 5-times more transplant centers performing least one A2/A2B to B case compared to the pre-KAS period.…”

“…Barriers to broadening the practice of A2/A2B to B transplantation are likely multi-faceted and may include issues such as lack of familiarity with the practice, or financial concerns given the known added costs of isohemagglutinin titer monitoring. 9 In this study, we sought to characterize the degree to which center-level practices of A2/A2B to B transplants have changed in the years following the implementation of the KAS. Specifically, we asked whether the increases in A2/A2B to B transplants that have been observed were a result of new adoption of this practice by centers where these transplants had not previously been performed, or whether it simply reflected centers already familiar with the practice increasing their volumes of these cases.…”

Discrepant subtyping of blood type A2 living kidney donors: Missed opportunities in kidney transplantation

“…While there are no published data on trends of non‐A1 to O transplantation, since these transplants occur only in the living donor setting and there is no policy mandating subtyping of blood type A living donors, we anticipate non‐A1 to O transplantation is even more underutilized. Factors for non‐A1 underutilization potentially include the need to develop detailed protocols, barriers to testing anti‐A titers regularly, limited availability of genotyping for group A subtypes, transplant center's experience with such transplants, and higher costs 15 . In this manuscript, we explored NKR's data and identified barriers to accurately subtyping blood type A and AB donors as a likely additional contributing factor.…”

“…Factors for non-A1 underutilization potentially include the need to develop detailed protocols, barriers to testing anti-A titers regularly, limited availability of genotyping for group A subtypes, transplant center's experience with such transplants, and higher costs. 15 In this manuscript, we explored NKR's data and identified barriers to accurately subtyping blood type A and AB donors as a likely additional contributing factor.…”

Expanding Blood Type A2‐to‐B Liver Transplantation: An Alternative for High Model for End‐Stage Liver Disease Score Patients

“…(1) A single-center retrospective cohort study of 29 A2-to-B deceased donor kidney transplants demonstrated no significant difference in patient or graft survival, serum creatinine, or glomerular filtration rate. (6) Notably, African Americans comprised 72% of the A2-to-B group. Furthermore, efforts to examine the association between ABO-incompatible liver transplantation in the United States have demonstrated a disproportionate advantage to African American and Asian candidates.…”