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Comparative Study
. 2016 Sep;31(9):1515-22.
doi: 10.1093/ndt/gfv446. Epub 2016 Feb 4.

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

Volker Assfalg  1 , Norbert Hüser  1 , Marieke van Meel  2 , Bernhard Haller  3 , Axel Rahmel  2 , Jan de Boer  2 , Edouard Matevossian  1 , Alexander Novotny  1 , Noël Knops  4 , Laurent Weekers  5 , Helmut Friess  6 , Johann Pratschke  7 , Reinhold Függer  8 , Otmar Janko  9 , Susanne Rasoul-Rockenschaub  10 , Jean-Louis Bosmans  11 , Nilufer Broeders  12 , Patrick Peeters  13 , Michel Mourad  14 , Dirk Kuypers  15 , Jasna Slaviček  16 , Anja Muehlfeld  17 , Florian Sommer  18 , Richard Viebahn  19 , Andreas Pascher  20 , Markus van der Giet  21 , Frans Zantvoort  22 , Rainer P Woitas  23 , Juliane Putz  24 , Klaus Grabitz  25 , Andreas Kribben  26 , Ingeborg Hauser  27 , Przemyslaw Pisarski  28 , Rolf Weimer  29 , Thomas Lorf  30 , Paola Fornara  31 , Christian Morath  32 , Björn Nashan  33 , Frank Lehner  34 , Volker Kliem  35 , Urban Sester  36 , Marc-Oliver Grimm  37 , Thorsten Feldkamp  38 , Robert Kleinert  39 , Wolfgang Arns  40 , Christian Mönch  41 , Markus Bo Schoenberg  42 , Martin Nitschke  43 , Bernd Krüger  44 , Stefan Thorban  45 , Helmut P Arbogast  46 , Heiner H Wolters  47 , Tanja Maier  48 , Jens Lutz  49 , Katharina Heller  50 , Bernhard Banas  51 , Oliver Hakenberg  52 , Martin Kalus  53 , Silvio Nadalin  54 , Frieder Keller  55 , Kai Lopau  56 , Frederike José Bemelman  57 , Shaikh Nurmohamed  58 , Jan-Stephan Sanders  59 , Johan W de Fijter  60 , Maarten Christiaans  61 , Luuk Hilbrands  62 , Michiel Betjes  63 , Arjan van Zuilen  64 , Uwe Heemann  65
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Free article
Comparative Study

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

Volker Assfalg et al. Nephrol Dial Transplant. 2016 Sep.
Free article

Abstract

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.

Keywords: graft survival; high-urgency; kidney; patient survival; renal; transplantation.

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