Renal transplantation across the ABO barrier using A(2) kidneys

Background. The waiting list for cadaveric kidney transplantation has conti nued to grow, and with the relative scarcity of cadaver donors, the median waiting time for patients in the United States increased to 824 days in 199 4, The median waiting times for patients with blood groups B or O were 1329 and 1007 days, respectively. Allocation of blood group A(2) kidneys (20% o f group A) to blood group O and B patients expands their potential donor po ol and shortens their waiting time for a kidney transplantation. Methods. Between May 1991 and June 1998, me transplanted 15 A(2) kidneys in to 6 blood group O and 9 blood group B patients. Anti-A isoagglutinins were measured before transplantation, and patients with anti-A(1) titers greate r than or equal to 1:8 underwent plasmapheresis (PP), Results. One patient with high titer anti-A antibodies, who did not receive PP, lost her allograft because of hyperacute rejection, Allograft function was excellent in the remaining 14 patients, with a mean serum creatinine l evel of 1.7 (+/-0.89) mg/dl at 1 month and 1.3 (+/-0.34) mg/dl at 1 year. T he actuarial 1-year graft survival rate was 93.3+/-6.4% and the patient sur vival rate was 100%. Conclusion, We conclude that the allocation of blood group A(2) kidneys for blood group O and B recipients is a practical way to expand the donor pool for these transplant candidates. PP may be important for reducing the leve ls of anti-A(2) and anti-A(2) antibodies and for reducing the risk of hyper acute rejection. Splenectomy seems to be unnecessary.