Grossman School of Medicine, New York University, New York, New York, USA.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Am J Transplant. 2024 Apr;24(4):606-618. doi: 10.1016/j.ajt.2023.12.015. Epub 2023 Dec 23.
Kidney transplantation from blood type A2/A2B donors to type B recipients (A2→B) has increased dramatically under the current Kidney Allocation System (KAS). Among living donor transplant recipients, A2-incompatible transplants are associated with an increased risk of all-cause and death-censored graft failure. In light of this, we used data from the Scientific Registry of Transplant Recipients from December 2014 until June 2022 to evaluate the association between A2→B listing and time to deceased donor kidney transplantation (DDKT) and post-DDKT outcomes for A2→B recipients. Among 53 409 type B waitlist registrants, only 12.6% were listed as eligible to accept A2→B offers ("A2-eligible"). The rates of DDKT at 1-, 3-, and 5-years were 32.1%, 61.4%, and 72.1% among A2-eligible candidates and 14.1%, 29.9%, and 44.1% among A2-ineligible candidates, with the former experiencing a 133% higher rate of DDKT (Cox weighted hazard ratio (wHR) = 2.33; P < .001). The 7-year adjusted mortality was comparable between A2→B and B-ABOc (type B/O donors to B recipients) recipients (wHR 0.94, P = .5). Moreover, there was no difference between A2→B vs B-ABOc DDKT recipients with regards to death-censored graft failure (wHR 1.00, P > .9) or all-cause graft loss (wHR 0.96, P = .6). Following its broader adoption since the implementation of the kidney allocation system, A2→B DDKT appears to be a safe and effective transplant modality for eligible candidates. As such, A2→B listing for eligible type B candidates should be expanded.
从血型 A2/A2B 供体向 B 受体(A2→B)的肾移植在当前的肾脏分配系统(KAS)下大幅增加。在活体供体移植受者中,A2 不相容的移植与全因和死亡原因排除的移植物失败风险增加相关。有鉴于此,我们使用了 2014 年 12 月至 2022 年 6 月期间来自移植受者科学注册处的数据,评估了 A2→B 列表与接受 A2→B 供体的死亡供体肾移植(DDKT)时间和 A2→B 受体的移植后结果之间的关联。在 53409 名 B 型候补注册者中,只有 12.6%被列为有资格接受 A2→B 供体(“A2 合格”)。在 A2 合格候选者中,1 年、3 年和 5 年的 DDKT 率分别为 32.1%、61.4%和 72.1%,而在 A2 不合格候选者中分别为 14.1%、29.9%和 44.1%,前者的 DDKT 率高 133%(Cox 加权风险比(wHR)=2.33;P<.001)。A2→B 和 B-ABOc(B/O 供体到 B 受体)受体的 7 年调整死亡率相当(wHR 0.94,P=.5)。此外,A2→B 与 B-ABOc DDKT 受者在死亡原因排除的移植物失败(wHR 1.00,P>.9)或全因移植物丢失(wHR 0.96,P=.6)方面没有差异。自肾脏分配系统实施以来,A2→B DDKT 的广泛采用似乎是合格候选者的一种安全有效的移植方式。因此,应扩大符合条件的 B 型候选者的 A2→B 列表。