Outcomes of A2/A2B to B Deceased Donor Kidney Transplantation: A Retrospective Study.

Background A2/A2B to B kidney transplantation has the potential to increase transplant access for traditionally disadvantaged blood group B minority candidates. Despite prior reports of positive post-transplant safety and clinical success, A2/A2B to B kidney transplantation remains underutilized in the United States. This study aims to investigate the post-transplant outcomes of A2/A2B to B kidney transplants performed at our center. Methods A retrospective study of all A2/A2B to B deceased donor kidney transplants (DDKTs) at our center from 2017 through 2023 was performed. Recipient and donor demographics, recipient medical history, time to transplant from listing, and post-transplant clinical outcomes were assessed, including one-year graft and patient survival. Results Of the 54 A2/A2B to B DDKTs performed during this period, 36 recipients were male, and 18 were female. The mean recipient age was 53.2 years. There were 22 (40.7%) African American recipients, 12 (22.2%) Hispanic recipients, 11 (20.3%) Caucasian recipients, eight (14.8%) Asian recipients, and one (1.8%) recipient of "other" race. The mean estimated post-transplant survival score was 46.5%. The mean donor age was 40.2 years, and the mean kidney donor profile index score was 44%. The mean time from waitlisting to transplant was 216 days. Delayed graft function was observed in five (9.2%) patients. Three (5.5%) patients had biopsy-proven acute rejection in the first year after transplant. The mean serum creatinine at one-year post-transplant was 1.4 mg/dL. At one-year post-transplant, graft survival was 96.2%, and patient survival was 98.1%. Conclusions Our study demonstrated excellent one-year post-transplant graft and patient survival rates with A2/A2B to B DDKT, with minority candidates predominantly benefiting from this.