■2014年,A2/A2B死亡供体肾脏移植的选择被纳入肾脏分配系统,以改善B血型候补名单候选人的获取。尽管报告的结果非常好,整个美国的中心使用率仍然很低。这里,我们研究了在单中心实施A2/A2B方案对B血型肾移植受者的影响,其中IgG的截止滴度≤1:8,IgM的截止滴度≤1:16.
■回顾性观察性研究。
■从2019年1月1日至2022年12月,在单个中心进行已故供体肾脏移植的B血型接受者。
■根据供血者血型,比较A2/A2B与血型的相容性,对已死亡供者肾移植的受者进行分析。
■患者一年生存率,死亡审查的同种异体移植功能,主要的非功能,延迟的移植物功能,使用血清肌酐水平和1年时估计的肾小球滤过率测量的同种异体移植功能,活检证实的排斥反应,并且需要血浆置换。
■使用分类变量的Fisher检验或χ2检验以及连续变量的非参数Wilcoxon秩和检验进行A2/A2B和相容组之间的比较。
■在研究期间,共有104名B型血患者在我们中心接受了已故供体肾脏移植,49人(47.1%)接受了A2/A2B移植。与血型兼容的受者相比,A2/A2B受者的等待时间更低(57.9个月比74.7个月,P=0.01)。A2/A2B受者在心脏死亡后更有可能接受供体(24.5%vs1.8%,P<0.05)和经历移植功能延迟(65.3%vs41.8%)。在1个月时,平均血清肌酐水平或估计的肾小球滤过率没有观察到差异,3个月,肾移植后1年,急性排斥反应,或主要不起作用。
■单中心研究。小队列规模限制结果分析。
■A2/A2B方案的实施使等待B血型患者的移植量增加了83.6%,并使移植等待时间减少了22.5%,移植结果相似。
受血者的血型是等待死者肾移植的时间的主要决定因素之一。在美国,B型血患者的肾脏等待时间最长。少数族裔占B血型候补患者的很大比例,有助于观察到肾移植率的种族差异。在这项研究中,与接受血型相容的肾脏相比,接受A2/A2B不相容的肾脏导致接受肾脏移植几乎提前18个月.接受A2/A2B肾脏的结果没有差异。
UNASSIGNED: The option for A2/A2B deceased donor kidney transplantation was integrated into the kidney allocation system in 2014 to improve access for B blood group waitlist candidates. Despite excellent reported outcomes, center uptake has remained low across the United States. Here, we examined the effect of implementing an A2/A2B protocol using a cutoff titer of ≤1:8 for IgG and ≤1:16 for IgM on blood group B kidney transplant recipients at a single center.
UNASSIGNED: Retrospective observational study.
UNASSIGNED: Blood group B recipients of deceased donor kidney transplants at a single center from January 1, 2019, to December 2022.
UNASSIGNED: Recipients of deceased donor kidney transplants were analyzed based on donor blood type with comparisons of A2/A2B versus blood group compatible.
UNASSIGNED: One-year patient survival, death-censored allograft function, primary nonfunction, delayed graft function, allograft function as measured using serum creatinine levels and estimated glomerular filtration rate at 1 year, biopsy-proven rejection, and need for plasmapheresis.
UNASSIGNED: Comparison between the A2/A2B and compatible groups were performed using the Fisher test or the χ2 test for categorical variables and the nonparametric Wilcoxon rank-sum test for continuous variables.
UNASSIGNED: A total of 104 blood type B patients received a deceased donor kidney transplant at our center during the study period, 49 (47.1%) of whom received an A2/A2B transplant. Waiting time was lower in A2/A2B recipients compared with blood group compatible recipients (57.9 months vs 74.7 months, P = 0.01). A2/A2B recipients were more likely to receive a donor after cardiac death (24.5% vs 1.8%, P < 0.05) and experience delayed graft function (65.3% vs 41.8%). There were no observed differences in the average serum creatinine level or estimated glomerular filtration rate at 1 month, 3 months, and 1 year post kidney transplantation, acute rejection, or primary nonfunction.
UNASSIGNED: Single-center study. Small cohort size limiting outcome analysis.
UNASSIGNED: Implementation of an A2/A2B protocol increased transplant volumes of blood group B waitlisted patients by 83.6% and decreased the waiting time for transplantation by 22.5% with similar transplant outcomes.
Recipient blood type is one of the main determinants of waiting time to receive a deceased donor kidney transplant. Patients with blood type B have some of the longest waiting times for a kidney in the United States. Minorities comprise a large percentage of blood group B waitlist patients, contributing to observed racial differences in kidney transplantation rates. In this study, accepting an A2/A2B incompatible kidney resulted in receiving a kidney transplant almost 18 months earlier compared with receiving a blood group compatible kidney. No differences in outcomes were seen by accepting A2/A2B kidneys.