Introduction. Since the implementation of the new Kidney Allocation System (KAS) few centers have implemented the use of A₂ donor kidneys into B recipients. Centers report a variety of barriers such as issues determining and updating eligibility of patients as well as expense of testing. As a result, fewer than 5% of patients nationally are listed as eligible to receive an A₂ kidney. Here we describe a successful setup to overcome the perceived barriers to listing.

Methods: In 10/2016 our center implemented a new screening program for determining the eligibility of patients to receive an A₂-to-B transplant. All blood group B patients now are tested every 3 months for anti-A₂ levels using serum left over following standard monthly cPRA testing. A single transplant coordinator was tasked with determining which patients were due for titers, submitting the order for testing, transporting the serum to the blood bank, and updating patient eligibility status after recording new titer values.

Results: Our blood group B waitlist averages 160 patients. Prior to initiation of the new screening protocol only 21% of patients on the B waitlist maintained clearance to receive A₂ kidneys. The remaining 79% of patients had either never been tested (6%), did not qualify for A2 transplants (31%) or had failed to update their testing and had their eligibility lapse (42%). 12 months after initiation of our new protocol, 74% of all patients have current clearance to receive A₂ kidneys (well above the national average of 4.5%). Among patients who are active on the blood group B waitlist, 100% have up to date testing (although 16% still have titers too high to allow A₂ transplantation). The weekly time commitment is about 5 hours per week.

Conclusion: An A₂-to-B program can be run with minimal burden and expense to transplant centers through a collaborative approach with an HLA laboratory. Coordinator time and logistic barriers should not preclude an active A₂ to B transplant program in even a large urban center.

CITATION INFORMATION: Radomski S., Diedrich B., Li D., Awwad M., Rosen-Bronson S., Langeberg A., Hamby A-.A., Cooper M., Gilbert A. Overcoming Barriers to Transplant: An A2 to B Program Need Not Be Difficult, Expensive, or Time Consuming Even for Large Centers Am J Transplant. 2017;17 (suppl 3).

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