First Report on the OPTN National Variance: Allocation of A2/A2B Deceased Donor Kidneys to Blood Group B Increases Minority Transplantation |
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Authors: | W. W. Williams W. S. Cherikh C. J. Young P. Y. Fan Y. Cheng D. A. Distant C. F. Bryan |
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Affiliation: | 1. MGH Transplant Center and Division of Nephrology, Massachusetts General Hospital, Boston, MA;2. United Network for Organ Sharing, Richmond, VA;3. University of Alabama at Birmingham, Birmingham, AL;4. University of Massachusetts Memorial Medical Center, Worcester, MA;5. SUNY HSC at Brooklyn University Hospitals, Brooklyn, NY;6. Midwest Transplant Network, Westwood, KS |
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Abstract: | 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. |
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Keywords: | health services and outcomes research kidney transplantation/nephrology Organ Procurement and Transplantation Network (OPTN) organ procurement and allocation recipient selection United Network for Organ Sharing (UNOS) waitlist management |
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