Advanced search
1 file | 536.05 KB

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

Author
Organization
Abstract
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. 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. 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. 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
WAITING TIME, SURVIVAL BENEFIT, DIALYSIS, CANDIDATES, PRIORITY, graft survival, high-urgency, kidney, patient survival, renal, transplantation

Downloads

  • (...).pdf
    • full text
    • |
    • UGent only
    • |
    • PDF
    • |
    • 536.05 KB

Citation

Please use this url to cite or link to this publication:

Chicago
Assfalg, Volker, Norbert Hueser, Marieke van Meel, Bernhard Haller, Axel Rahmel, Jan de Boer, Edouard Matevossian, et al. 2016. “High-urgency Kidney Transplantation in the Eurotransplant Kidney Allocation System : Success or Waste of Organs? : the Eurotransplant 15-year All-centre Survey.” Nephrology Dialysis Transplantation 31 (9): 1515–1522.
APA
Assfalg, V., Hueser, N., van Meel, M., Haller, B., Rahmel, A., de Boer, J., Matevossian, E., et al. (2016). High-urgency kidney transplantation in the Eurotransplant Kidney Allocation System : success or waste of organs? : the Eurotransplant 15-year all-centre survey. NEPHROLOGY DIALYSIS TRANSPLANTATION, 31(9), 1515–1522.
Vancouver
1.
Assfalg V, Hueser N, van Meel M, Haller B, Rahmel A, de Boer J, et al. High-urgency kidney transplantation in the Eurotransplant Kidney Allocation System : success or waste of organs? : the Eurotransplant 15-year all-centre survey. NEPHROLOGY DIALYSIS TRANSPLANTATION. 2016;31(9):1515–22.
MLA
Assfalg, Volker et al. “High-urgency Kidney Transplantation in the Eurotransplant Kidney Allocation System : Success or Waste of Organs? : the Eurotransplant 15-year All-centre Survey.” NEPHROLOGY DIALYSIS TRANSPLANTATION 31.9 (2016): 1515–1522. Print.
@article{8502907,
  abstract     = {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. 
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. 
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. 
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.},
  author       = {Assfalg, Volker and Hueser, Norbert and van Meel, Marieke and Haller, Bernhard and Rahmel, Axel and de Boer, Jan and Matevossian, Edouard and Novotny, Alexander and Knops, Noel and Weekers, Laurent and Friess, Helmut and Pratschke, Johann and Fuegger, Reinhold and Janko, Otmar and Rasoul-Rockenschaub, Susanne and Bosmans, Jean-Louis and Broeders, Nilufer and Peeters, Patrick and Mourad, Michel and Kuypers, Dirk and Slavicek, Jasna and Muehlfeld, Anja and Sommer, Florian and Viebahn, Richard and Pascher, Andreas and van der Giet, Markus and Zantvoort, Frans and Woitas, Rainer P and Putz, Juliane and Grabitz, Klaus and Kribben, Andreas and Hauser, Ingeborg and Pisarski, Przemyslaw and Weimer, Rolf and Lorf, Thomas and Fornara, Paola and Morath, Christian and Nashan, Bjoern and Lehner, Frank and Kliem, Volker and Sester, Urban and Grimm, Marc-Oliver and Feldkamp, Thorsten and Kleinert, Robert and Arns, Wolfgang and Moench, Christian and Schoenberg, Markus Bo and Nitschke, Martin and Krueger, Bernd and Thorban, Stefan and Arbogast, Helmut P and Wolters, Heiner H and Maier, Tanja and Lutz, Jens and Heller, Katharina and Banas, Bernhard and Hakenberg, Oliver and Kalus, Martin and Nadalin, Silvio and Keller, Frieder and Lopau, Kai and Bemelman, Frederike Jose and Nurmohamed, Shaikh and Sanders, Jan-Stephan and de Fijter, Johan W and Christiaans, Maarten and Hilbrands, Luuk and Betjes, Michiel and van Zuilen, Arjan and Heemann, Uwe},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keywords     = {WAITING TIME,SURVIVAL BENEFIT,DIALYSIS,CANDIDATES,PRIORITY,graft survival,high-urgency,kidney,patient survival,renal,transplantation},
  language     = {eng},
  number       = {9},
  pages        = {1515--1522},
  title        = {High-urgency kidney transplantation in the Eurotransplant Kidney Allocation System : success or waste of organs? : the Eurotransplant 15-year all-centre survey},
  url          = {http://dx.doi.org/10.1093/ndt/gfv446},
  volume       = {31},
  year         = {2016},
}

Altmetric
View in Altmetric
Web of Science
Times cited: