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

Volker Assfalg; Norbert Hueser; Marieke van Meel; Bernhard Haller; Axel Rahmel; Jan de Boer; Edouard Matevossian; Alexander Novotny; Noel Knops; Laurent Weekers; Helmut Friess; Johann Pratschke; Reinhold Fuegger; Otmar Janko; Susanne Rasoul-Rockenschaub; Jean-Louis Bosmans; Nilufer Broeders; Patrick Peeters; Michel Mourad; Dirk Kuypers; Jasna Slavicek; Anja Muehlfeld; Florian Sommer; Richard Viebahn; Andreas Pascher; Markus van der Giet; Frans Zantvoort; Rainer P. Woitas; Juliane Putz; Klaus Grabitz; Andreas Kribben; Ingeborg Hauser; Przemyslaw Pisarski; Rolf Weimer; Thomas Lorf; Paola Fornara; Christian Morath; Bjoern Nashan; Frank Lehner; Volker Kliem; Urban Sester; Marc-Oliver Grimm; Thorsten Feldkamp; Robert Kleinert; Wolfgang Arns; Christian Moench; Markus Bo Schoenberg; Martin Nitschke; Bernd Krueger; Stefan Thorban; Helmut P. Arbogast; Heiner H. Wolters; Tanja Maier; Jens Lutz; Katharina Heller; Bernhard Banas; Oliver Hakenberg; Martin Kalus; Silvio Nadalin; Frieder Keller; Kai Lopau; Frederike Jose Bemelman; Shaikh Nurmohamed; Jan-Stephan Sanders; Johan W. de Fijter; Maarten Christiaans; Luuk Hilbrands; Michiel Betjes; Arjan van Zuilen; Uwe Heemann

doi:10.1093/ndt/gfv446

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

Volker Assfalg^*, Norbert Hueser, Marieke van Meel, Bernhard Haller, Axel Rahmel, Jan de Boer, Edouard Matevossian, Alexander Novotny, Noel Knops, Laurent Weekers, Helmut Friess, Johann Pratschke, Reinhold Fuegger, Otmar Janko, Susanne Rasoul-Rockenschaub, Jean-Louis Bosmans, Nilufer Broeders, Patrick Peeters, Michel Mourad, Dirk KuypersJasna Slavicek, Anja Muehlfeld, Florian Sommer, Richard Viebahn, Andreas Pascher, Markus van der Giet, Frans Zantvoort, Rainer P. Woitas, Juliane Putz, Klaus Grabitz, Andreas Kribben, Ingeborg Hauser, Przemyslaw Pisarski, Rolf Weimer, Thomas Lorf, Paola Fornara, Christian Morath, Bjoern Nashan, Frank Lehner, Volker Kliem, Urban Sester, Marc-Oliver Grimm, Thorsten Feldkamp, Robert Kleinert, Wolfgang Arns, Christian Moench, Markus Bo Schoenberg, Martin Nitschke, Bernd Krueger, Stefan Thorban, Helmut P. Arbogast, Heiner H. Wolters, Tanja Maier, Jens Lutz, Katharina Heller, Bernhard Banas, Oliver Hakenberg, Martin Kalus, Silvio Nadalin, Frieder Keller, Kai Lopau, Frederike Jose Bemelman, Shaikh Nurmohamed, Jan-Stephan Sanders, Johan W. de Fijter, Maarten Christiaans, Luuk Hilbrands, Michiel Betjes, Arjan van Zuilen, Uwe Heemann

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	1515-1522
Journal	Nephrology Dialysis Transplantation
Volume	31
Issue number	9
DOIs	https://doi.org/10.1093/ndt/gfv446
Publication status	Published - Sept 2016

Keywords

graft survival
high-urgency
kidney
patient survival
renal
transplantation

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10.1093/ndt/gfv446

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Assfalg, V., Hueser, N., van Meel, M., Haller, B., Rahmel, A., de Boer, J., Matevossian, E., Novotny, A., Knops, N., Weekers, L., Friess, H., Pratschke, J., Fuegger, R., Janko, O., Rasoul-Rockenschaub, S., Bosmans, J.-L., Broeders, N., Peeters, P., Mourad, M., ... Heemann, U. (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. https://doi.org/10.1093/ndt/gfv446

@article{34ce7cf6cf864ff48317be905079019f,

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

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 = "graft survival, high-urgency, kidney, patient survival, renal, transplantation",

author = "Volker Assfalg and Norbert Hueser and {van Meel}, Marieke and Bernhard Haller and Axel Rahmel and {de Boer}, Jan and Edouard Matevossian and Alexander Novotny and Noel Knops and Laurent Weekers and Helmut Friess and Johann Pratschke and Reinhold Fuegger and Otmar Janko and Susanne Rasoul-Rockenschaub and Jean-Louis Bosmans and Nilufer Broeders and Patrick Peeters and Michel Mourad and Dirk Kuypers and Jasna Slavicek and Anja Muehlfeld and Florian Sommer and Richard Viebahn and Andreas Pascher and {van der Giet}, Markus and Frans Zantvoort and Woitas, {Rainer P.} and Juliane Putz and Klaus Grabitz and Andreas Kribben and Ingeborg Hauser and Przemyslaw Pisarski and Rolf Weimer and Thomas Lorf and Paola Fornara and Christian Morath and Bjoern Nashan and Frank Lehner and Volker Kliem and Urban Sester and Marc-Oliver Grimm and Thorsten Feldkamp and Robert Kleinert and Wolfgang Arns and Christian Moench and Schoenberg, {Markus Bo} and Martin Nitschke and Bernd Krueger and Stefan Thorban and Arbogast, {Helmut P.} and Wolters, {Heiner H.} and Tanja Maier and Jens Lutz and Katharina Heller and Bernhard Banas and Oliver Hakenberg and Martin Kalus and Silvio Nadalin and Frieder Keller and Kai Lopau and Bemelman, {Frederike Jose} and Shaikh Nurmohamed and Jan-Stephan Sanders and {de Fijter}, {Johan W.} and Maarten Christiaans and Luuk Hilbrands and Michiel Betjes and {van Zuilen}, Arjan and Uwe Heemann",

year = "2016",

month = sep,

doi = "10.1093/ndt/gfv446",

language = "English",

volume = "31",

pages = "1515--1522",

journal = "Nephrology Dialysis Transplantation",

issn = "0931-0509",

publisher = "Oxford University Press",

number = "9",

}

Assfalg, V, Hueser, N, van Meel, M, Haller, B, Rahmel, A, de Boer, J, Matevossian, E, Novotny, A, Knops, N, Weekers, L, Friess, H, Pratschke, J, Fuegger, R, Janko, O, Rasoul-Rockenschaub, S, Bosmans, J-L, Broeders, N, Peeters, P, Mourad, M, Kuypers, D, Slavicek, J, Muehlfeld, A, Sommer, F, Viebahn, R, Pascher, A, van der Giet, M, Zantvoort, F, Woitas, RP, Putz, J, Grabitz, K, Kribben, A, Hauser, I, Pisarski, P, Weimer, R, Lorf, T, Fornara, P, Morath, C, Nashan, B, Lehner, F, Kliem, V, Sester, U, Grimm, M-O, Feldkamp, T, Kleinert, R, Arns, W, Moench, C, Schoenberg, MB, Nitschke, M, Krueger, B, Thorban, S, Arbogast, HP, Wolters, HH, Maier, T, Lutz, J, Heller, K, Banas, B, Hakenberg, O, Kalus, M, Nadalin, S, Keller, F, Lopau, K, Bemelman, FJ, Nurmohamed, S, Sanders, J-S, de Fijter, JW, Christiaans, M, Hilbrands, L, Betjes, M, van Zuilen, A & Heemann, U 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, vol. 31, no. 9, pp. 1515-1522. https://doi.org/10.1093/ndt/gfv446

High-urgency kidney transplantation in the Eurotransplant Kidney Allocation System: success or waste of organs? The Eurotransplant 15-year all-centre survey. / Assfalg, Volker; Hueser, Norbert; van Meel, Marieke et al.
In: Nephrology Dialysis Transplantation, Vol. 31, No. 9, 09.2016, p. 1515-1522.

Research output: Contribution to journal › Article › Academic › peer-review

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 - Hueser, Norbert

AU - van Meel, Marieke

AU - Haller, Bernhard

AU - Rahmel, Axel

AU - de Boer, Jan

AU - Matevossian, Edouard

AU - Novotny, Alexander

AU - Knops, Noel

AU - Weekers, Laurent

AU - Friess, Helmut

AU - Pratschke, Johann

AU - Fuegger, 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 - Slavicek, 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, Bjoern

AU - Lehner, Frank

AU - Kliem, Volker

AU - Sester, Urban

AU - Grimm, Marc-Oliver

AU - Feldkamp, Thorsten

AU - Kleinert, Robert

AU - Arns, Wolfgang

AU - Moench, Christian

AU - Schoenberg, Markus Bo

AU - Nitschke, Martin

AU - Krueger, 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 Jose

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

PY - 2016/9

Y1 - 2016/9

N2 - 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.

AB - 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.

KW - graft survival

KW - high-urgency

KW - kidney

KW - patient survival

KW - renal

KW - transplantation

U2 - 10.1093/ndt/gfv446

DO - 10.1093/ndt/gfv446

M3 - Article

C2 - 26908765

SN - 0931-0509

VL - 31

SP - 1515

EP - 1522

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

IS - 9

ER -

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

Abstract

Keywords

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