1. Improving Access to Kidney Transplantation without Decreasing Graft Survival: Long-Term Outcomes of Blood Group A2/A2B Deceased Donor Kidneys in B Recipients
- Author
-
Christopher F. Bryan, Paul W. Nelson, Daniel Murillo, Franz T. Winklhofer, Gilbert Ross, Bradley A. Warady, and Charles F. Shield
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Urinary system ,medicine.medical_treatment ,ABO Blood-Group System ,Isoantibodies ,ABO blood group system ,Cadaver ,medicine ,Humans ,Organ donation ,Minority Groups ,Kidney transplantation ,Survival analysis ,Retrospective Studies ,Transplantation ,Kidney ,business.industry ,Graft Survival ,Immunosuppression ,Middle Aged ,medicine.disease ,Kidney Transplantation ,Survival Analysis ,Tissue Donors ,Surgery ,Treatment Outcome ,surgical procedures, operative ,medicine.anatomical_structure ,Female ,business - Abstract
Background. The transplantation of blood group A 2 /A 2 B deceased donor kidneys into B recipients could improve access to transplantation for blood group B recipients. However, this practice is controversial, and long-term data are lacking. This study analyzed the long-term outcomes of A 2 /A 2 B deceased donor kidneys transplanted into selected B recipients. Methods. We retrospectively assessed the outcomes (graft survival, transplant rates, and acute rejection) of deceased-donor kidneys using an allocation system that transplanted A 2 /A 2 B donors into B recipients with low anti-A blood group antibody titers between 1994 and 2003. Patients received conventional immunosuppression without any specific antibody reduction procedures. We further assessed the impact this system had on access to transplantation by blood group. Results. Of 1,400 kidney transplants, 56 (4.0%) were A 2 /A 2 B to B recipients. The system reduced waiting time for all B recipients, even shorter than for blood group A recipients (median waiting times of A 2 /A 2 B to B transplants=182 days vs. B to B transplants=297 days; and A to A=307 days). Although there was a trend toward increased acute rejection in A 2 /A 2 B to B transplants, the actuarial 7-year death censored graft survival was 72% for B recipients regardless of donor type. Conclusions. Transplanting A 2 /A 2 B deceased donor kidneys into B recipients leads to an equalization of waiting time between blood groups with similar patient and graft survival using conventional immunosuppression. This protocol could lead to more equal access to kidney transplantation in blood group B recipients.
- Published
- 2005