Skip to main content

Main menu

  • About Us
    • Leadership
    • Our Team
    • Vision, Mission and Values
    • Health and Economic Impact
    • Research Impact Video
    • Strategic Plan
  • Our Research
    • Research Focus
      • Brain Health
      • Cancer
      • Digital Health and Artificial Intelligence
      • Heart Health
      • Healthy Aging and Mobility
      • Immune System
      • Injury and Rehabilitation
      • Lung Health
      • Mental Health and Substance Use
    • Research Centres and Programs
      • BC Centre on Substance Use
      • Centre for Aging SMART
      • Centre for Cardiovascular Innovation
      • Centre for Clinical Epidemiology and Evaluation
      • Centre for Lung Health
      • Djavad Mowafaghian Centre for Brain Health
      • Immunity and Infection Research Centre
      • International Collaboration On Repair Discoveries
      • M. H. Mohseni Institute of Urologic Sciences
      • Ovarian Cancer Research Centre
      • Community Research Program
      • Emergency Medicine Research Program
      • Hematology Research Program
      • Skin Research Program
      • Other Research Focus Areas
    • News and Stories
    • Researcher Directory
    • Events and Workshops
  • Research Services
    • New to VCHRI
      • Working at VCHRI
      • Regulations and Training
      • Membership with VCHRI
      • Learning and Development
    • Starting Your Project
      • Research Facilitation
      • Awards and Funding
      • Grant Management
      • Operational Approval
      • CST Cerner
    • Developing Your Project
      • Clinical Trials Administration
      • Clinical Research Unit
      • Research Privacy
      • Financial Policies and Procedures
    • Additional Support
      • Indigenous Health Research Unit
      • VCH-VCHRI AI Hub
      • Communications and Media Relations
      • Study Recruitment Support
      • Innovation and Industry Partnership
    • Internal Awards
    • Clinical Research
    • Indigenous Research
  • Participate in Research
    • Reasons to Participate
    • Participant Stories
    • Find a Study
    • Recruitment Support

User menu

  • Log in

Breadcrumb

  1. Home
  2. Our Research
  3. News and Stories
  4. Blood type matters for kidney patient priority

Blood type matters for kidney patient priority

Stories Sep 15, 2022 4 minutes

Researchers discovered that kidney patients who were the hardest to match with donors were not receiving the priority they required.

There are currently over 550 patients in British Columbia on a waitlist for a kidney transplant. New research led by Vancouver Coastal Health Research Institute researcher Dr. James Lan — published in the American Journal of Transplantation — found that the system used to prioritize patients who are difficult to match with a potential donor has overlooked an important variable: their blood type.

“The game-changer we discovered was that, if you were in blood group O or B, you were likely to be more disadvantaged when it comes to being prioritized with a kidney,” says Lan. 

“Giving a kidney to the right patient at the right time is predicted to increase the efficiency and fairness of the kidney transplant system as a whole.” 

Kidney candidates on the transplant waitlist are currently screened for the presence of antibodies against immune molecules called human leukocyte antigens (HLA). 

HLA sensitization occurs when a person’s immune system is exposed to HLA molecules that are foreign to their own body. For example, in the event of a blood transfusion or pregnancy, an individual’s immune system recognizes the HLA proteins of the blood product or fetus as foreign, thereby triggering an immune response to produce anti-HLA antibodies.

Dr. James Lan is an assistant professor in the Department of Pathology and Laboratory Medicine and the Division of Nephrology at the University of British Columbia. He is the medical director of the Vancouver Immunology Laboratory and a transplant nephrologist in the Kidney Transplant Program at Vancouver General Hospital.

 

For decades, it has been known that antibodies directed against a donor kidney can lead to severe kidney rejection. Because of this, HLA sensitization can make it challenging for a kidney patient to find a matching donor. 

“For some patients, their calculated panel reactive antibody (cPRA) — a measure of how likely their body will react to a random kidney donor — is zero, which means that they can match with any kidney donor,” explains Lan. “Other patients may have a cPRA of 99 per cent, meaning that they only match with one donor out of 100.”

Patients with a cPRA of 95 per cent or higher are placed in the hard-to-match category and receive priority status, adds Lan. Priority status gives patients access to donors from across Canada instead of only within their province of residence, as is the case for non-priority-status patients. 

“It is essential to give priority status to a patient for whom it will be hard to find a matching donor.”

What Lan and his team discovered was that HLA sensitization is only part of the picture when it comes to determining a patient’s cPRA. The missing element is the consideration of patients’ ABO blood type.

For instance, blood type O patients can only receive kidneys from donors that are also blood type O. Blood type A patients can only match donors that are blood type A or O. Similarly, blood type B candidates can only match with blood type B or O donors. In contrast, blood type AB patients can receive a kidney from donors with any blood type. 

This means that patients with O blood type have a more limited donor pool than other blood types, yet blood type was previously not considered when determining whether a patient should receive priority status or in the ranking of priority.

The new blood type inclusive model, called the ABO-adjusted cPRA, designed by Lan and his colleagues addresses this missing piece of the puzzle. By integrating blood type into the equation, the ABO-adjusted cPRA more accurately captures all hard-to-match kidney patients, ensuring that they get appropriate priority when a match becomes available.

Dr. Loren Gragert is an assistant professor at the Tulane Cancer Center in the Department of Pathology and Laboratory Medicine at the Tulane University School of Medicine.

The ABO-adjusted cPRA system was developed in collaboration with Dr. Loren Gragert from the Tulane University School of Medicine in New Orleans, Louisiana. Gragert brought to the team essential technological know-how in the areas of HLA informatics and population genetics datasets used in kidney donor registries.

Gragert and Lan’s novel calculation, which merges ABO and HLA sensitization to compute overall immune sensitization in a single metric, is a global first to their knowledge, says Gragert. 

Giving kidneys to patients who need it most

Dialysis patients receive treatment using a dialysis machine that removes waste, extra water and salt from their bloodstream that their kidneys are no longer able to adequately process. Dialysis also rebalances chemicals in the body, as well as blood pressure.

While dialysis is an essential, life-extending procedure, patients on dialysis awaiting a kidney transplant have around a 50 per cent chance of survival after five years, making it a race against time to find a matching donor. 

“Patients on dialysis often cannot work, they feel terrible the day they receive dialysis and the day after because the procedure completely drains their energy,” explains Lan. 

“Getting patients off of dialysis as soon as possible can dramatically improve their longevity and quality of life.”

A greater proportion of people of Black, Hispanic and Indigenous descent have blood type O than people of Caucasian ancestry. Similarly a greater percentage of people of Asian and Black descent have blood type B than Caucasians. Accounting for A, B or O blood type in kidney donor matching protocols could then remove any potential disparities related to a patient’s ethnicity.

In addition, dialysis costs the health care system around $100,000 per year per patient, Lan adds, versus $20,000 per year for anti-transplant medication.

“The system works better when hard-to-match patients receive appropriate priority status,” says Lan. “This might be their only opportunity for a match, versus patients with a bigger pool of eligible donors who are more likely to find a match within the first five years of being on dialysis.”

“The ABO-adjusted cPRA metric is a more accurate approach that places a kidney in the patient who needs it the most so that they will not miss out on a potentially once-in-a-lifetime opportunity.” 
 

Researchers

James Lan

Related Articles

Ask an expert: What should I know about kidney stones?

Transforming kidney transplantation with pioneering epitope-based matching

Preventing heart attack and stroke in patients with kidney disease

Share:

  • Facebook
  • Linkedin
  • Twitter
  • Email

Get the latest research headlines in your inbox

Subscribe

Recent News and Stories

Type
Announcement

Celebrating the life and distinguished career of Dr. Marcel Dvorak

May 14, 2025
Type
Stories

More equitable representation needed in Parkinson’s research

May 9, 2025 parkinsons, patient engagement, women
Type
Stories

Gamified stroke recovery improves arm function

May 8, 2025 stroke, rehabilitation
See more news

Get updates!

Join our newsletter mailing list to stay up to date on features and releases.

Subscribe

Quick Links

  • News and Stories
  • Careers
  • Events
  • Media Enquiries

Follow Us

  • LinkedIn
  • X
  • YouTube

© 2025 VCHRI. All rights reserved.

  • Contact
  • Privacy Policy