Improving access to minorities with A2 to B kidney transplantation: A systematic review and meta-analysis

Background: Studies have shown that A2 kidney transplants for blood group B recipients offer comparable graft and patient survival rates to ABO-compatible transplants, potentially improving transplant access for B recipients. However, the adoption of this strategy has been controversial. Methods: We...

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Main Authors: Patricia Viana, Maria Meritxell Roca Mora, Jorge Eduardo Persson, André Milani-Reis, Harold Cliff Sullivan, Idelberto Raul Badell, Juliano Riella
Format: Article
Language:English
Published: Elsevier 2025-09-01
Series:Transplantation Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S2451959625000113
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Summary:Background: Studies have shown that A2 kidney transplants for blood group B recipients offer comparable graft and patient survival rates to ABO-compatible transplants, potentially improving transplant access for B recipients. However, the adoption of this strategy has been controversial. Methods: We conducted a Systematic-Review and Meta-Analysis, comparing non-A1to B versus B to B blood type in kidney transplant patients. MEDLINE, Embase, and Cochrane databases were searched for studies that met our inclusion criteria. We analyzed binary and continuous endpoints using odds ratios (OR) and mean difference (MD), respectively, with a 95% confidence interval (CI). P-value < 0.05 was considered statistically significant. Results: We included five studies with 14,959 patients, of whom 2,121 (14.2%) were non-A1 to B blood. No statistically significant differences were found between the groups for patient survival (OR 1.08; 95% CI 0.95 to 1.22; p=0.6), graft survival (OR 1.1; 95% CI 0.99 to 1.23; p=0.96), eGRF (MD 7.8 mL/min/1.73m2; 95% CI -8.27 to 23.87 mL/min/1.73m2; p=1.0), antibody-mediated rejection (OR 1.51; 95% CI 0.43 to 5.28; p = 0.52), and T-cell-mediated rejection (OR 1.12; 95% CI 0.43 to 2.93; p = 0.81). Conclusion: We found no significant differences in patient and graft survival between non-A1 to B and B to B kidney transplantation. This finding underscores the potential to expand the donor pool without compromising outcomes, which has a profound impact on reducing waiting times and improving equity in renal transplant access.
ISSN:2451-9596