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 Stippel; Katharina 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

doi:10.1097/TP.0000000000003964

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-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 language	English
Pages (from-to)	1215-1226
Number of pages	12
Journal	Transplantation
Volume	106
Issue number	6
Early online date	4 Oct 2021
DOIs	https://doi.org/10.1097/TP.0000000000003964
Publication status	Published - Jun 2022

Keywords

COLD ISCHEMIA TIME
GRAFT FAILURE
MORTALITY
RECIPIENTS
RISK
FRAILTY
ASSOCIATION
PREDICTOR
SURVIVAL
DIALYSIS

Access to Document

10.1097/TP.0000000000003964

Cite this

Assfalg, V., Miller, G., Stocker, F., van Meel, M., Groenevelt, T., Tieken, I., Ankerst, D., Renders, L., Novotny, A., Hartmann, D., Jell, A., Rahmel, A., Wahba, R., Muehlfeld, A., Bouts, A., Ysebaert, D., Globke, B., Jacobs-Tulleneers-Thevissen, D., Piros, L., ... Heemann, U. (2022). Kidney Transplantation after Rescue Allocation - the Eurotransplant Experience: A Retrospective Multicenter Outcome Analysis. Transplantation, 106(6), 1215-1226. https://doi.org/10.1097/TP.0000000000003964

@article{9751761a64b542758a05cbc698bb2801,

title = "Kidney Transplantation after Rescue Allocation - the Eurotransplant Experience: A Retrospective Multicenter Outcome Analysis",

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.",

keywords = "COLD ISCHEMIA TIME, GRAFT FAILURE, MORTALITY, RECIPIENTS, RISK, FRAILTY, ASSOCIATION, PREDICTOR, SURVIVAL, DIALYSIS",

author = "Volker Assfalg and Gregor Miller and Felix Stocker and {van Meel}, Marieke and Tiny Groenevelt and Ineke Tieken and Donna Ankerst and Lutz Renders and Alexander Novotny and Daniel Hartmann and Alissa Jell and Axel Rahmel and Roger Wahba and Anja Muehlfeld and Antonia Bouts and Dirk Ysebaert and Brigitta Globke and Daniel Jacobs-Tulleneers-Thevissen and L{\'a}szl{\'o} Piros and Dirk Stippel and Katharina Heller and Ute Eisenberger and {van Laecke}, Steven and Rolf Weimer and Rosenkranz, {Alexander R} and Stefan Berger and Lutz Fischer and Volker Kliem and Florian Vondran and Urban Sester and Stefan Schneeberger and Ana Harth and Dirk Kuypers and Reinhold F{\"u}gger and Miha Arnol and Maarten Christiaans and Julia Weinmann-Menke and Bernd Kr{\"u}ger and Luuk Hilbrands and Bernhard Banas and Oliver Hakenberg and Robert Minnee and Vedat Schwenger and Nils Heyne and {van Zuilen}, Arjan and Roman Reindl-Schwaighofer and Kai Lopau and Norbert Hu{\"u}ser and Uwe Heemann",

year = "2022",

month = jun,

doi = "10.1097/TP.0000000000003964",

language = "English",

volume = "106",

pages = "1215--1226",

journal = "Transplantation",

issn = "0041-1337",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "6",

}

Assfalg, V, Miller, G, Stocker, F, van Meel, M, Groenevelt, T, Tieken, I, Ankerst, D, Renders, L, Novotny, A, Hartmann, D, Jell, A, Rahmel, A, Wahba, R, Muehlfeld, A, Bouts, A, Ysebaert, D, Globke, B, Jacobs-Tulleneers-Thevissen, D, Piros, L, Stippel, D, Heller, K, Eisenberger, U, van Laecke, S, Weimer, R, Rosenkranz, AR, Berger, S, Fischer, L, Kliem, V, Vondran, F, Sester, U, Schneeberger, S, Harth, A, Kuypers, D, Függer, R, Arnol, M, Christiaans, M, Weinmann-Menke, J, Krüger, B, Hilbrands, L, Banas, B, Hakenberg, O, Minnee, R, Schwenger, V, Heyne, N, van Zuilen, A, Reindl-Schwaighofer, R, Lopau, K, Huüser, N & Heemann, U 2022, 'Kidney Transplantation after Rescue Allocation - the Eurotransplant Experience: A Retrospective Multicenter Outcome Analysis', Transplantation, vol. 106, no. 6, pp. 1215-1226. https://doi.org/10.1097/TP.0000000000003964

TY - JOUR

T1 - Kidney Transplantation after Rescue Allocation - the Eurotransplant Experience

T2 - A Retrospective Multicenter Outcome Analysis

AU - Assfalg, Volker

AU - Miller, Gregor

AU - Stocker, Felix

AU - van Meel, Marieke

AU - Groenevelt, Tiny

AU - Tieken, Ineke

AU - Ankerst, Donna

AU - Renders, Lutz

AU - Novotny, Alexander

AU - Hartmann, Daniel

AU - Jell, Alissa

AU - Rahmel, Axel

AU - Wahba, Roger

AU - Muehlfeld, Anja

AU - Bouts, Antonia

AU - Ysebaert, Dirk

AU - Globke, Brigitta

AU - Jacobs-Tulleneers-Thevissen, Daniel

AU - Piros, László

AU - Stippel, Dirk

AU - Heller, Katharina

AU - Eisenberger, Ute

AU - van Laecke, Steven

AU - Weimer, Rolf

AU - Rosenkranz, Alexander R

AU - Berger, Stefan

AU - Fischer, Lutz

AU - Kliem, Volker

AU - Vondran, Florian

AU - Sester, Urban

AU - Schneeberger, Stefan

AU - Harth, Ana

AU - Kuypers, Dirk

AU - Függer, Reinhold

AU - Arnol, Miha

AU - Christiaans, Maarten

AU - Weinmann-Menke, Julia

AU - Krüger, Bernd

AU - Hilbrands, Luuk

AU - Banas, Bernhard

AU - Hakenberg, Oliver

AU - Minnee, Robert

AU - Schwenger, Vedat

AU - Heyne, Nils

AU - van Zuilen, Arjan

AU - Reindl-Schwaighofer, Roman

AU - Lopau, Kai

AU - Huüser, Norbert

AU - Heemann, Uwe

PY - 2022/6

Y1 - 2022/6

N2 - 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.

AB - 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.

KW - COLD ISCHEMIA TIME

KW - GRAFT FAILURE

KW - MORTALITY

KW - RECIPIENTS

KW - RISK

KW - FRAILTY

KW - ASSOCIATION

KW - PREDICTOR

KW - SURVIVAL

KW - DIALYSIS

U2 - 10.1097/TP.0000000000003964

DO - 10.1097/TP.0000000000003964

M3 - Article

C2 - 34608103

SN - 0041-1337

VL - 106

SP - 1215

EP - 1226

JO - Transplantation

JF - Transplantation

IS - 6

ER -