High-urgency kidney transplantation in the Eurotransplant Kidney Allocation System success or waste of organs? The Eurotransplant 15-year all-centre survey

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 -