Kidney Transplantation after Rescue Allocation - the Eurotransplant Experience: A Retrospective Multicenter Outcome Analysis

Volker Assfalg, Gregor Miller, Felix Stocker, Marieke van Meel, Tiny Groenevelt, Ineke Tieken, Donna Ankerst, Lutz Renders, Alexander Novotny, Daniel Hartmann, Alissa Jell, Axel Rahmel, Roger Wahba, Anja Muehlfeld, Antonia Bouts, Dirk Ysebaert, Brigitta Globke, Daniel Jacobs-Tulleneers-Thevissen, László Piros, Dirk StippelKatharina Heller, Ute Eisenberger, Steven van Laecke, Rolf Weimer, Alexander R Rosenkranz, Stefan Berger, Lutz Fischer, Volker Kliem, Florian Vondran, Urban Sester, Stefan Schneeberger, Ana Harth, Dirk Kuypers, Reinhold Függer, Miha Arnol, Maarten Christiaans, Julia Weinmann-Menke, Bernd Krüger, Luuk Hilbrands, Bernhard Banas, Oliver Hakenberg, Robert Minnee, Vedat Schwenger, Nils Heyne, Arjan van Zuilen, Roman Reindl-Schwaighofer, Kai Lopau, Norbert Huüser, Uwe Heemann

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: At Eurotransplant (ET), kidneys are transferred to 'rescue allocation' (RA), whenever the standard allocation (SA) algorithms Eurotransplant kidney allocation system (ETKAS) and Eurotransplant senior program (ESP) fail. We analyzed the outcome of RA.

METHODS: Retrospective patient clinical and demographic characteristics association analyses with graft outcomes for 2,421 recipients of a deceased donor renal transplantation (DDRT) after RA versus 25,475 after SA from 71 centers across all ET countries from 2006 to 2018.

RESULTS: Numbers of DDRTs after RA increased over the time, especially in Germany. RA played a minor role in ESP vs. ETKAS (2.7% vs. 10.4%). RA recipients and donors were older compared to SA recipients and donors, cold ischemia times were longer, waiting times were shorter, and the incidence of primary non-function was comparable. Among ETKAS-recipients, HLA matching was more favorable in SA (mean 3.7 vs. 2.5). In multivariate modeling, the incidence of death with a functioning graft (DwFG) in ETKAS was reduced in RA compared to SA (subdistribution hazard ratio 0.70, 95% confidence interval [0.60-0.81], p<0.001) whereas other outcomes (mortality, graft loss) were not significantly different. None of the three outcomes were significantly different when comparing RA with SA within the ESP program.

CONCLUSIONS: Facing increased waiting times and mortality on dialysis due to donor shortage, this study reveals encouragingly positive DDRT outcomes following RA. This supports the extension of RA to more patients and as an alternative tool to enable transplantation in patients in countries with prohibitively long waiting times or at risk of deterioration.Supplemental Visual Abstract; http://links.lww.com/TP/C297.

Original languageEnglish
JournalTransplantation
DOIs
Publication statusE-pub ahead of print - 4 Oct 2021

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