Impact of the new kidney allocation system A2/A2B --> B policy on access to transplantation among minority candidates
Department of Surgery, Transplant and Hepatobiliary Surgery Division, UMass Memorial Medical Center
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Bioethics and Medical Ethics | Health Policy | Health Services Administration | Health Services Research | Nephrology | Race and Ethnicity | Surgery
Blood group B candidates, many of whom represent ethnic minorities, have historically had diminished access to deceased donor kidney transplantation (DDKT). The new national kidney allocation system (KAS) preferentially allocates blood group A2/A2B deceased donor kidneys to B recipients to address this ethnic and blood group disparity. No study has yet examined the impact of KAS on A2 incompatible (A2i) DDKT for blood group B recipients overall or among minorities. A case-control study of adult blood group B DDKT recipients from 2013 to 2017 was performed, as reported to the Scientific Registry of Transplant Recipients. Cases were defined as recipients of A2/A2B kidneys, whereas controls were all remaining recipients of non-A2/A2B kidneys. A2i DDKT trends were compared from the pre-KAS (1/1/2013-12/3/2014) to the post-KAS period (12/4/2014-2/28/2017) using multivariable logistic regression. Post-KAS, there was a 4.9-fold increase in the likelihood of A2i DDKT, compared to the pre-KAS period (odds ratio [OR] 4.92, 95% confidence interval [CI] 3.67-6.60). However, compared to whites, there was no difference in the likelihood of A2i DDKT among minorities post-KAS. Although KAS resulted in increasing A2/A2B-->B DDKT, the likelihood of A2i DDKT among minorities, relative to whites, was not improved. Further discussion regarding A2/A2B-->B policy revisions aiming to improve DDKT access for minorities is warranted.
disparities, ethics and public policy, ethnicity/race, health services and outcomes research, kidney transplantation/nephrology, organ procurement and allocation
DOI of Published Version
Am J Transplant. 2018 Aug;18(8):1947-1953. doi: 10.1111/ajt.14719. Epub 2018 Mar 31. Link to article on publisher's site
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
Martins, Paulo N.A.; Mustian, Margaux N.; MacLennan, Paul A.; Ortiz, Jorge A.; Akoad, Mohamed; Caicedo, Juan Carlos; Echeverri, Gabriel J.; Gray, Stephen H.; Lopez-Soler, Reynold I.; Gunasekaran, Ganesh; Kelly, Beau; Mobley, Constance M.; Black, Sylvester M.; Esquivel, Carlos; and Locke, Jayme E., "Impact of the new kidney allocation system A2/A2B --> B policy on access to transplantation among minority candidates" (2018). Surgery Publications and Presentations. 173.