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Kidney transplant options for African Americans may increase with new kidney allocation system
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Comparable outcomes were seen with A2 to B vs. B to B kidney transplants after 3 years of experience under a new kidney allocation system used at a single center, according to recently published results. The new allocation system may improve access to kidney transplants for African Americans, who are the majority of A2 kidney recipients at this center.
"In order to rectify the disparity in access to kidney transplantation for blood group B recipients, the majority of whom are minorities, UNOS instituted a policy of A2 to B kidney transplantation as part of the new kidney allocation system in December, 2014," David Shaffer, MD, FACS, of Vanderbilt University Medical Center, told Healio/Nephrology. "Our study reports comparable three year outcomes of A2 to B kidney transplants compared to B to B transplants at Vanderbilt."
Researchers from the United Network for Organ Sharing performed a retrospective, single-center cohort analysis of 29 consecutive A2 to B and 50 B to B deceased donor kidney transplantations performed between December 2014 and December 2017, which was after the implementation of a new kidney allocation system. Investigators prospectively monitored preoperative and postoperative anti-A titers. Post-transplant anti- A titers, patients and graft survival, renal function and hospital costs were among the outcomes.
Results showed 72% of patients in the A2 to B group were African Americans vs. 60% in the B to B group. No difference was seen in the mean wait time. Based on results from paired tests, the anti-A IgG titers in the A2 to B group deceased donor kidney transplantations increased at discharge and at 4 weeks postoperatively. No significant difference was seen in patient or graft survival, serum creatine or eGFR. However, during the follow-up period, serum creatine and eGFR were different between the groups. The A2 to B group compared with B to B group had significantly higher mean transplant total hospital costs and hospital costs per net organ acquisition costs.
"A2 to B kidney transplantation is a practical and effective way for centers to reduce disparities in access to kidney transplantation for minority recipients," Shaffer said. – by Monica Jaramillo
Disclosure: The study was supported by the Clinical and Translational Science Award
No. UL1TR000445 from the National Center for Advancing Translational Sciences.
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