First Report on the OPTN National Variance: Allocation of A2/A2B Deceased Donor Kidneys to Blood Group B Increases Minority Transplantation

• Published in: American journal of transplantation Vol. 15; no. 12; pp. 3134 - 3142
• Main Authors: Williams, W. W., Cherikh, W. S., Young, C. J., Fan, P. Y., Cheng, Y., Distant, D. A., Bryan, C. F.
• Format: Journal Article
• Language: English
• Published: Malden Elsevier Limited 01.12.2015
• Subjects: Antigens; Blood groups; health services and outcomes research; kidney transplantation/nephrology; Kidneys; organ procurement and allocation; Organ Procurement and Transplantation Network (OPTN); recipient selection; Transplants & implants; United Network for Organ Sharing (UNOS); waitlist management
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.13409

In 2002, the Organ Procurement and Transplantation Network (OPTN) Minority Affairs Committee (MAC) implemented a national, prospective, “variance of practice” to allow deceased donor, ABO blood group incompatible, A2 antigen, kidney transplantation into blood group B recipients; outcomes of this cohort were compared to ABO compatible recipients. The goal of the variance was to increase the number of transplants to B candidates without negatively impacting survival or compromising system equity. Only B recipients with low anti‐A IgG titers (<1:8) were eligible to receive these kidneys. Across eight participating Donation Service Areas (DSA), there were 101 A2/A2B to B transplants through 12/31/11, of which the majority of the recipients (61%) were ethnic minorities. At 12, 24, and 36 months, Kaplan–Meier graft survival rates for the B recipients of A2/A2B kidneys were 95.0%, 90.6%, and 85.4%, respectively, comparable to outcomes for B recipients of B kidneys, 92.6%, 87.9%, and 82.5%, respectively (p‐value = 0.48). Five DSAs increased the proportion of B transplants during 41 months postvariance, with a lesser proportional decrease in blood group A transplants. The data support the proposition that this allocation algorithm may provide a robust mechanism to increase access of blood group B minority candidates to kidney transplantation. In this first report on the OPTN/UNOS/Minority Affairs Committee‐sponsored variance of practice to allow deceased donor, A2 donor antigen, ABO‐incompatible kidney transplantation into blood group B recipients, the authors provide evidence that the outcomes for these cohorts are identical to blood group B‐to‐B controls, and that this new rule provides a robust and equitable mechanism to increase the rate of transplantation for ethnic minorities in the U.S.