Blood type B kidney transplant candidates have a longer wait time on the deceased donor list, an average of 6 years compared to 3 years for blood type A. This burden falls disproportionately on ethnic minorities who represent a majority of all blood type B listed candidates, hence the implementation of KAS in December 2015 allocating Non-A1 and Non-A1B to B candidates. To participate, centers were required to establish policies for consent and titer thresholds. Despite comparable outcomes to ABO compatible transplants center participation nationally in this program has been dismal at 18% at 18 months post KAS.

Method: we participated early in the program and adopted the published anti-A titer of ≤1:8. After more than a year of participation we noticed the low enrollment rate in the program, <10% for blood type B despite universal titer measurement. This led to discussions with transfusion medicine and review of our titer method compared to what is published in the literature, Bryan CF AJT 2016. Our lab method does not utilize dithiothreitol (DTT) and does include AHG. Titers are measured utilizing A1 cells with the tube method after immediate spin without DTT and then after adding AHG to improve IgG detection. We identified that our method is very sensitive compared to published reports leading to an increase in titer threshold to 32.

Results: Increasing the titer cutoff improved overall enrollment to 50%. We compared titer characteristics and outcomes before and after titer threshold increment. The number of transplants has increased and there were no significant differences in outcomes between the groups.

Conclusion: to improve enrollment in this program, centers need to carefully review blood type B participation and engage their local blood bank to compare the titer method used in the context of the previously published literature.

CITATION INFORMATION: Khamash H., Adamski J., Heilman R., Mathur A., Moss A., Kumar A., Lu Q., Reddy K. Improving Participation in Non-A1/Non-A1B to B Deceased Donor Program Post Kidney Allocation System (KAS)- A Single Center Experience Am J Transplant. 2017;17 (suppl 3).

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