title: Increased access to transplantation for blood group B cadaveric waiting list candidates by using A2 kidneys: time for a new national system?
abstract: Since blood group B end-stage renal disease (ESRD) patients have less access to donor kidneys and a higher minority composition than any other blood group, the United Network for Organ Sharing (UNOS) approved a voluntary national kidney allocation variance to allow organ procurement organizations (OPOs) to preferentially allocate A2 and A2B kidneys to B candidates. The Midwest Transplant Network OPO has preferentially allocated and transplanted kidneys from blood group A2 and A2B donors to our blood group B waiting list candidates for more than 7 years to increase access to kidneys for the B candidates on our OPO-wide waiting list. Between 1994 and 2000, a total of 121 blood group B ESRD patients from our OPO-wide cadaveric kidney waiting list were transplanted. Thirty-four per cent (41/121) of those B candidates received either an A2 or an A2B kidney. One- and 5-year graft survival rates for the group of B recipients of A2 or A2B kidneys were 91 and 85% (died with functioning graft [DWFG] censored), respectively, which were not significantly different from those of 91 and 80% for the 80 B recipients of B or O kidneys (Wilcoxon = 0.48; log-rank = 0.55). These data support the national trial for additional OPOs to voluntarily allocate A2 and A2B kidneys preferentially to B waiting list candidates, thus increasing access of blood group B patients to renal transplantation.
authors.affiliation: Saint Luke's Hospital and the University of Missouri, Kansas City, USA.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Nelson
authors.forename: Charles F
authors.initials: CF
authors.lastname: Shield
authors.forename: Nicolas A
authors.initials: NA
authors.lastname: Muruve
authors.forename: Daniel
authors.initials: D
authors.lastname: Murillo
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Warady
authors.forename: Mark I
authors.initials: MI
authors.lastname: Aeder
authors.forename: Christopher F
authors.initials: CF
authors.lastname: Bryan
mesh_terms: D000017:ABO Blood-Group System; D000328:Adult; D001787:Blood Group Incompatibility; D002102:Cadaver; D005260:Female; D006801:Humans; D007668:Kidney; D016030:Kidney Transplantation / Q000502:physiology / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D014481:United States; D014850:Waiting Lists
chemical_list: D000017:ABO Blood-Group System