title: First Report on the OPTN National Variance: Allocation of A2 /A2 B Deceased Donor Kidneys to Blood Group B Increases Minority Transplantation.
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 /A2 B 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 /A2 B 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.
authors.affiliation: MGH Transplant Center and Division of Nephrology, Massachusetts General Hospital, Boston, MA.
authors.forename: W W
authors.initials: WW
authors.lastname: Williams
authors.affiliation: United Network for Organ Sharing, Richmond, VA.
authors.forename: W S
authors.initials: WS
authors.lastname: Cherikh
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL.
authors.forename: C J
authors.initials: CJ
authors.lastname: Young
authors.affiliation: University of Massachusetts Memorial Medical Center, Worcester, MA.
authors.forename: P Y
authors.initials: PY
authors.lastname: Fan
authors.affiliation: United Network for Organ Sharing, Richmond, VA.
authors.forename: Y
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: SUNY HSC at Brooklyn University Hospitals, Brooklyn, NY.
authors.forename: D A
authors.initials: DA
authors.lastname: Distant
authors.affiliation: Midwest Transplant Network, Westwood, KS.
authors.forename: C F
authors.initials: CF
authors.lastname: Bryan
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001787:Blood Group Incompatibility / Q000276:immunology*; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D011379:Prognosis; D040841:Resource Allocation; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D000017:ABO Blood-Group System; D007518:Isoantibodies
keywords: Organ Procurement and Transplantation Network (OPTN); United Network for Organ Sharing (UNOS); health services and outcomes research; kidney transplantation/nephrology; organ procurement and allocation; recipient selection; waitlist management