A2/A2B to B Renal Transplantation: Past, Present, and Future Directions

One component of the new national kidney allocation system (KAS) in the United States that was implemented on December 4, 2014, was the allocation of kidneys from A(2) and A(2)B (A, non-A(1) and AB, non-A(1)B) deceased donors into blood group B candidates (A(2)/A(2)B -> B). In so far as this is an important component of the new KAS that has the potential to further increase the access to transplantation for blood group B candidates on the waiting list, most of whom are minority candidates, we will review the body of evidence and historical perspectives that led to its inclusion in the new KAS. This review will also describe prospects for more widespread use of A(2)/A(2)B -> B transplantation and a novel mechanism of humoral immunosuppression in B patients before and after transplantation with an A(2) or A(2)B kidney.