Among living donor kidney transplant (LDKT) recipients, those who receive a blood type A2 incompatible organ have higher risks of graft failure than those receiving a blood type compatible organ, according to investigators presenting at the 2020 virtual American Transplant Congress.

In the Scientific Registry of Transplant Recipients (SRTR) 2000-2018, a total of 304 patients with blood type O or B received an A2 incompatible kidney from a living donor. (A blood type O recipient could accept an A2 kidney and a blood type B recipient an A2 or A2B kidney.) Patient survival and mortality appeared comparable between groups, Allan B. Massie, PhD, MHS, and colleagues from Johns Hopkins School of Medicine in Baltimore, MD, reported. Survival rates at 1, 5, and 10 years were 98%, 92%, and 79% among compatible LDKT recipients, and 99%, 93%, and 79% among A2 incompatible LDKT recipients. A2 incompatible donors also had a nonsignificant 11% lower mortality rate.

With respect to graft failure, however, A2 incompatible recipients had a significant 30% and 60% higher risk for all-cause and death-censored graft failure over at least 15 years, respectively, the investigators reported.

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A2 incompatible donor and recipient pairs should be counseled about the increased risk for graft failure and referred for kidney paired donation, according to Dr Massie’s team. They recommended that kidney paired donation matching algorithms incorporate this increased risk.


Getsin S, Chiang P, Yu S, Jackson K, Segev D, Massie A. Graft and Patient Survival After A2-Incompatible Living Donor Kidney Transplantation. Am J Transplant. 2020; 20 (suppl 3). Abstract C-053.