10-YEAR EXPERIENCE IN TRANSPLANTATION OF A(2) KIDNEYS INTO B-RECIPIENTS AND O-RECIPIENTS

Background. This article summarizes our 10-year multicenter experience with transplantation of 50 blood group A(2) and A(2)B kidneys into B and O patients, Methods. Since 1986, we have transplanted kidneys from 46 cadaver donors and 4 living donors who were blood group A(2) (47 d onors) or A(2)B (3 donors) into 19 B and 31 O patients. In 1991, we be gan allocating these kidneys preferentially to B and O recipients who were selected based on a history of low (less than or equal to 4) anti -A IgG isoagglutinin titers, Immunosuppression was no different from t hat used in ABO-compatible grafts, Results. The 1-month function rate before thus selecting the patients was 68% (19/28), but is now 94% (17 /18), Two-year cadaver-donor graft survival with this selection method is 94%, compared with 88% for 640 concurrent and consecutive ABO-comp atible transplants (log-rank, 0.15). All four living-related transplan ts are still functioning, with a mean follow-up of 71 months. Since we began allocating A(2) kidneys preferentially to B and O recipients, t he percentage of the B patients who received A(2) or A(2)B kidneys has increased from 29% (8/28) to 55% (10/18). Conclusions. Transplantatio n of A(2) or A(2)B kidneys into B and O patients is clinically equival ent to that of ABO-compatible transplantation when recipients are sele cted by low pretransplant anti-A titer histories. This approach increa ses access of blood group B recipients to kidneys.