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 journalArticleAcademicpeer-review


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 languageEnglish
Pages (from-to)1515-1522
JournalNephrology Dialysis Transplantation
Issue number9
Publication statusPublished - Sept 2016


  • graft survival
  • high-urgency
  • kidney
  • patient survival
  • renal
  • transplantation

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