High-urgency kidney transplantation in the Eurotransplant Kidney Allocation System success or waste of organs? The Eurotransplant 15-year all-centre survey
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High-urgency kidney transplantation in the Eurotransplant Kidney Allocation System success or waste of organs? The Eurotransplant 15-year all-centre survey. / Assfalg, Volker; Hüser, Norbert; van Meel, Marieke; Haller, Bernhard; Rahmel, Axel; de Boer, Jan; Matevossian, Edouard; Novotny, Alexander; Knops, Noël; Weekers, Laurent; Friess, Helmut; Pratschke, Johann; Függer, Reinhold; Janko, Otmar; Rasoul-Rockenschaub, Susanne; Bosmans, Jean-Louis; Broeders, Nilufer; Peeters, Patrick; Mourad, Michel; Kuypers, Dirk; Slaviček, Jasna; Muehlfeld, Anja; Sommer, Florian; Viebahn, Richard; Pascher, Andreas; van der Giet, Markus; Zantvoort, Frans; Woitas, Rainer P; Putz, Juliane; Grabitz, Klaus; Kribben, Andreas; Hauser, Ingeborg; Pisarski, Przemyslaw; Weimer, Rolf; Lorf, Thomas; Fornara, Paola; Morath, Christian; Nashan, Björn; Lehner, Frank; Kliem, Volker; Sester, Urban; Grimm, Marc-Oliver; Feldkamp, Thorsten; Kleinert, Robert; Arns, Wolfgang; Mönch, Christian; Schoenberg, Markus Bo; Nitschke, Martin; Krüger, Bernd; Thorban, Stefan; Arbogast, Helmut P; Wolters, Heiner H; Maier, Tanja; Lutz, Jens; Heller, Katharina; Banas, Bernhard; Hakenberg, Oliver; Kalus, Martin; Nadalin, Silvio; Keller, Frieder; Lopau, Kai; Bemelman, Frederike José; Nurmohamed, Shaikh; Sanders, Jan-Stephan; de Fijter, Johan W; Christiaans, Maarten; Hilbrands, Luuk; Betjes, Michiel; van Zuilen, Arjan; Heemann, Uwe.
in: NEPHROL DIAL TRANSPL, Jahrgang 31, Nr. 9, 09.2016, S. 1515-22.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - High-urgency kidney transplantation in the Eurotransplant Kidney Allocation System success or waste of organs? The Eurotransplant 15-year all-centre survey
AU - Assfalg, Volker
AU - Hüser, Norbert
AU - van Meel, Marieke
AU - Haller, Bernhard
AU - Rahmel, Axel
AU - de Boer, Jan
AU - Matevossian, Edouard
AU - Novotny, Alexander
AU - Knops, Noël
AU - Weekers, Laurent
AU - Friess, Helmut
AU - Pratschke, Johann
AU - Függer, Reinhold
AU - Janko, Otmar
AU - Rasoul-Rockenschaub, Susanne
AU - Bosmans, Jean-Louis
AU - Broeders, Nilufer
AU - Peeters, Patrick
AU - Mourad, Michel
AU - Kuypers, Dirk
AU - Slaviček, Jasna
AU - Muehlfeld, Anja
AU - Sommer, Florian
AU - Viebahn, Richard
AU - Pascher, Andreas
AU - van der Giet, Markus
AU - Zantvoort, Frans
AU - Woitas, Rainer P
AU - Putz, Juliane
AU - Grabitz, Klaus
AU - Kribben, Andreas
AU - Hauser, Ingeborg
AU - Pisarski, Przemyslaw
AU - Weimer, Rolf
AU - Lorf, Thomas
AU - Fornara, Paola
AU - Morath, Christian
AU - Nashan, Björn
AU - Lehner, Frank
AU - Kliem, Volker
AU - Sester, Urban
AU - Grimm, Marc-Oliver
AU - Feldkamp, Thorsten
AU - Kleinert, Robert
AU - Arns, Wolfgang
AU - Mönch, Christian
AU - Schoenberg, Markus Bo
AU - Nitschke, Martin
AU - Krüger, Bernd
AU - Thorban, Stefan
AU - Arbogast, Helmut P
AU - Wolters, Heiner H
AU - Maier, Tanja
AU - Lutz, Jens
AU - Heller, Katharina
AU - Banas, Bernhard
AU - Hakenberg, Oliver
AU - Kalus, Martin
AU - Nadalin, Silvio
AU - Keller, Frieder
AU - Lopau, Kai
AU - Bemelman, Frederike José
AU - Nurmohamed, Shaikh
AU - Sanders, Jan-Stephan
AU - de Fijter, Johan W
AU - Christiaans, Maarten
AU - Hilbrands, Luuk
AU - Betjes, Michiel
AU - van Zuilen, Arjan
AU - Heemann, Uwe
N1 - © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
PY - 2016/9
Y1 - 2016/9
N2 - BACKGROUND: In the Eurotransplant Kidney Allocation System (ETKAS), transplant candidates can be considered for high-urgency (HU) status in case of life-threatening inability to undergo renal replacement therapy. Data on the outcomes of HU transplantation are sparse and the benefit is controversial.METHODS: We systematically analysed data from 898 ET HU kidney transplant recipients from 61 transplant centres between 1996 and 2010 and investigated the 5-year patient and graft outcomes and differences between relevant subgroups.RESULTS: Kidney recipients with an HU status were younger (median 43 versus 55 years) and spent less time on the waiting list compared with non-HU recipients (34 versus 54 months). They received grafts with significantly more mismatches (mean 3.79 versus 2.42; P < 0.001) and the percentage of retransplantations was remarkably higher (37.5 versus 16.7%). Patient survival (P = 0.0053) and death with a functioning graft (DwFG; P < 0.0001) after HU transplantation were significantly worse than in non-HU recipients, whereas graft outcome was comparable (P = 0.094). Analysis according to the different HU indications revealed that recipients listed HU because of an imminent lack of access for dialysis had a significantly worse patient survival (P = 0.0053) and DwFG (P = 0.0462) compared with recipients with psychological problems and suicidality because of dialysis. In addition, retransplantation had a negative impact on patient and graft outcome.CONCLUSIONS: Facing organ shortages, increasing wait times and considerable mortality on dialysis, we question the current policy of HU allocation and propose more restrictive criteria with regard to individuals with vascular complications or repeated retransplantations in order to support patients on the non-HU waiting list with a much better long-term prognosis.
AB - BACKGROUND: In the Eurotransplant Kidney Allocation System (ETKAS), transplant candidates can be considered for high-urgency (HU) status in case of life-threatening inability to undergo renal replacement therapy. Data on the outcomes of HU transplantation are sparse and the benefit is controversial.METHODS: We systematically analysed data from 898 ET HU kidney transplant recipients from 61 transplant centres between 1996 and 2010 and investigated the 5-year patient and graft outcomes and differences between relevant subgroups.RESULTS: Kidney recipients with an HU status were younger (median 43 versus 55 years) and spent less time on the waiting list compared with non-HU recipients (34 versus 54 months). They received grafts with significantly more mismatches (mean 3.79 versus 2.42; P < 0.001) and the percentage of retransplantations was remarkably higher (37.5 versus 16.7%). Patient survival (P = 0.0053) and death with a functioning graft (DwFG; P < 0.0001) after HU transplantation were significantly worse than in non-HU recipients, whereas graft outcome was comparable (P = 0.094). Analysis according to the different HU indications revealed that recipients listed HU because of an imminent lack of access for dialysis had a significantly worse patient survival (P = 0.0053) and DwFG (P = 0.0462) compared with recipients with psychological problems and suicidality because of dialysis. In addition, retransplantation had a negative impact on patient and graft outcome.CONCLUSIONS: Facing organ shortages, increasing wait times and considerable mortality on dialysis, we question the current policy of HU allocation and propose more restrictive criteria with regard to individuals with vascular complications or repeated retransplantations in order to support patients on the non-HU waiting list with a much better long-term prognosis.
KW - Journal Article
U2 - 10.1093/ndt/gfv446
DO - 10.1093/ndt/gfv446
M3 - SCORING: Journal article
C2 - 26908765
VL - 31
SP - 1515
EP - 1522
JO - NEPHROL DIAL TRANSPL
JF - NEPHROL DIAL TRANSPL
SN - 0931-0509
IS - 9
ER -