Transplant of serologic A₁ but genotype A2 kidneys to ABO O and B recipients is Feasible and safe.

BACKGROUND: Kidney transplants from ABO A2 donors to O and B recipients reduce wait times without compromising outcomes. Recent work shows that ABO genotyping more accurately identifies A2 donors than serologic methods. Here, we show that kidneys from donors labeled A1 by serology but genotyped as A2 can be safely transplanted to O and B recipients with favorable outcomes, expanding access for disadvantaged populations. METHODS: . Genotyping was performed by real time PCR or next generation sequencing. Data were analyzed for biopsy-proven rejection, anti-HLA/anti-ABO antibodies, and allograft loss. RESULTS: . In this cohort allograft survival was 100%. No graft losses were attributed to ABO incompatibility. CONCLUSIONS: by serology but confirmed as A2 by genotyping into O and B recipients is safe and can expand the donor pool for disadvantaged candidates. Our findings support adopting ABO genotyping as a routine supplement to serologic testing.