Impact of the new kidney allocation system A2/A2B → B policy on access to transplantation among minority candidates

Paulo N. Martins, Margaux N. Mustian, Paul A. MacLennan, Jorge A. Ortiz, Mohamed Akoad, Juan Carlos Caicedo, Gabriel J. Echeverri, Stephen H. Gray, Reynold I. Lopez-Soler, Ganesh Gunasekaran, Beau Kelly, Constance M. Mobley, Sylvester M. Black, Carlos Esquivel, Jayme E. Locke

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


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.

Original languageEnglish
Pages (from-to)1947-1953
Number of pages7
JournalAmerican Journal of Transplantation
Issue number8
StatePublished - Aug 2018
Externally publishedYes


  • disparities
  • ethics and public policy
  • ethnicity/race
  • health services and outcomes research
  • kidney transplantation/nephrology
  • organ procurement and allocation


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