High-urgency kidney transplantation in the Eurotransplant Kidney Allocation System: success or waste of organs? The Eurotransplant 15-year all-centre survey.
نویسندگان
چکیده
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.
منابع مشابه
Organ allocation systems and management of the renal transplant waiting list.
In 1996 the EUROTRANSPLANT organisation, which currently includes the member-states Austria, Belgium, Germany, Luxemburg, the Netherlands and Slovenia, changed its policy of renal donor organ allocation to the new algorithm ETKAS (Eurotransplant Kidney Allocation System). Its main goal was to shorten the average and maximum waiting time, adjust for rare HLA phenotypes and homozygosities, achiev...
متن کاملExpanding the donor pool to increase renal transplantation.
INTRODUCTION The goal of the Eurotransplant renal allocation scheme is to provide every patient on the waiting list with a reasonably balanced opportunity for a donor offer. New initiatives were taken in order to maximize donor usage while maintaining a successful transplant outcome. METHODS Two Eurotransplant projects were launched in order to accommodate changes in donor and recipient profi...
متن کاملEnhanced kidney allocation to highly sensitized patients by the acceptable mismatch program.
Even in this era of efficient immunosuppression, a positive serological crossmatch caused by complement fixing antibodies directed against the human leukocyte antigen (HLA) mismatches of the organ donor is a contraindication for transplantation (1). The presence of this type of antibodies is known to be associated with a high incidence of hyper acute or acute-accelerated rejection (2). Highly s...
متن کاملRenal transplantation in the elderly: surgical complications and outcome with special emphasis on the Eurotransplant Senior Programme.
BACKGROUND The purpose of this retrospective study was to evaluate the results of the Eurotransplant Senior Programme (ESP) within our centre compared to elderly recipients >or=60 years from the regular Eurotransplant Kidney Allocation System (ETKAS), specifically focusing on surgical aspects. METHODS Data from 73 ESP patients (average donor/recipient age: 71.1/67.1) were compared with those ...
متن کاملProteomics and peritoneal dialysis: early days but clear potential*
1. Wolfe RA, Ashby VB, Milford EL et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 1999; 341: 1725–1730 2. De Meester J, Persijn GG, Wujciak T et al. Eurotransplant International Foundation. The new Eurotransplant kidney allocation system: report one year after implementation. ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
دوره 31 9 شماره
صفحات -
تاریخ انتشار 2016