Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation-A Retrospective Multicenter Outcome Analysis

Volker Assfalg; Gregor Miller; Felix Stocker; Norbert Hüser; Daniel Hartmann; Uwe Heemann; Ineke Tieken; Wouter Zanen; Serge Vogelaar; Alexander R Rosenkranz; Stefan Schneeberger; Reinhold Függer; Gabriela Berlakovich; Dirk R Ysebaert; Daniel Jacobs-Tulleneers-Thevissen; Dimitri Mikhalski; Steven van Laecke; Dirk Kuypers; Anja S Mühlfeld; Richard Viebahn; Johann Pratschke; Sebastian Melchior; Ingeborg A Hauser; Bernd Jänigen; Rolf Weimer; Nicolas Richter; Susan Foller; Kevin Schulte; Christine Kurschat; Ana Harth; Christian Moench; Sebastian Rademacher; Martin Nitschke; Bernhard K Krämer; Lutz Renders; Dionysios Koliogiannis; Andreas Pascher; Joachim Hoyer; Julia Weinmann-Menke; Mario Schiffer; Bernhard Banas; Oliver Hakenberg; Vedat Schwenger; Silvio Nadalin; Kai Lopau; Laszlo Piros; Balazs Nemes; Peter Szakaly; Antonia Bouts; Frederike J Bemelman; Martinus Christiaans; Et al.

doi:10.1097/TP.0000000000004878

Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation-A Retrospective Multicenter Outcome Analysis

Volker Assfalg^*, Gregor Miller, Felix Stocker, Norbert Hüser, Daniel Hartmann, Uwe Heemann, Ineke Tieken, Wouter Zanen, Serge Vogelaar, Alexander R Rosenkranz, Stefan Schneeberger, Reinhold Függer, Gabriela Berlakovich, Dirk R Ysebaert, Daniel Jacobs-Tulleneers-Thevissen, Dimitri Mikhalski, Steven van Laecke, Dirk Kuypers, Anja S Mühlfeld, Richard ViebahnJohann Pratschke, Sebastian Melchior, Ingeborg A Hauser, Bernd Jänigen, Rolf Weimer, Nicolas Richter, Susan Foller, Kevin Schulte, Christine Kurschat, Ana Harth, Christian Moench, Sebastian Rademacher, Martin Nitschke, Bernhard K Krämer, Lutz Renders, Dionysios Koliogiannis, Andreas Pascher, Joachim Hoyer, Julia Weinmann-Menke, Mario Schiffer, Bernhard Banas, Oliver Hakenberg, Vedat Schwenger, Silvio Nadalin, Kai Lopau, Laszlo Piros, Balazs Nemes, Peter Szakaly, Antonia Bouts, Frederike J Bemelman, Martinus Christiaans, Et al.

^*Corresponding author for this work

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

Abstract

BACKGROUND: Whenever the kidney standard allocation (SA) algorithms according to the Eurotransplant (ET) Kidney Allocation System or the Eurotransplant Senior Program fail, rescue allocation (RA) is initiated. There are 2 procedurally different modes of RA: recipient oriented extended allocation (REAL) and competitive rescue allocation (CRA). The objective of this study was to evaluate the association of patient survival and graft failure with RA mode and whether or not it varied across the different ET countries. METHODS: The ET database was retrospectively analyzed for donor and recipient clinical and demographic characteristics in association with graft outcomes of deceased donor renal transplantation (DDRT) across all ET countries and centers from 2014 to 2021 using Cox proportional hazards methods. RESULTS: Seventeen thousand six hundred seventy-nine renal transplantations were included (SA 15?658 [89%], REAL 860 [4.9%], and CRA 1161 [6.6%]). In CRA, donors were older, cold ischemia times were longer, and HLA matches were worse in comparison with REAL and especially SA. Multivariable analyses showed comparable graft and recipient survival between SA and REAL; however, CRA was associated with shorter graft survival. Germany performed 76% of all DDRTs after REAL and CRA and the latter mode reduced waiting times by up to 2.9 y. CONCLUSIONS: REAL and CRA are used differently in the ET countries according to national donor rates. Both RA schemes optimize graft utilization, lead to acceptable outcomes, and help to stabilize national DDRT programs, especially in Germany.

Original language	English
Journal	Transplantation
DOIs	https://doi.org/10.1097/TP.0000000000004878
Publication status	E-pub ahead of print - 11 Dec 2023

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10.1097/TP.0000000000004878

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Assfalg, V., Miller, G., Stocker, F., Hüser, N., Hartmann, D., Heemann, U., Tieken, I., Zanen, W., Vogelaar, S., Rosenkranz, A. R., Schneeberger, S., Függer, R., Berlakovich, G., Ysebaert, D. R., Jacobs-Tulleneers-Thevissen, D., Mikhalski, D., van Laecke, S., Kuypers, D., Mühlfeld, A. S., ... Et al. (2023). Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation-A Retrospective Multicenter Outcome Analysis. Transplantation. Advance online publication. https://doi.org/10.1097/TP.0000000000004878

@article{03bbab20788f42a08c4ff5053eb323df,

title = "Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation-A Retrospective Multicenter Outcome Analysis",

abstract = "BACKGROUND: Whenever the kidney standard allocation (SA) algorithms according to the Eurotransplant (ET) Kidney Allocation System or the Eurotransplant Senior Program fail, rescue allocation (RA) is initiated. There are 2 procedurally different modes of RA: recipient oriented extended allocation (REAL) and competitive rescue allocation (CRA). The objective of this study was to evaluate the association of patient survival and graft failure with RA mode and whether or not it varied across the different ET countries. METHODS: The ET database was retrospectively analyzed for donor and recipient clinical and demographic characteristics in association with graft outcomes of deceased donor renal transplantation (DDRT) across all ET countries and centers from 2014 to 2021 using Cox proportional hazards methods. RESULTS: Seventeen thousand six hundred seventy-nine renal transplantations were included (SA 15?658 [89%], REAL 860 [4.9%], and CRA 1161 [6.6%]). In CRA, donors were older, cold ischemia times were longer, and HLA matches were worse in comparison with REAL and especially SA. Multivariable analyses showed comparable graft and recipient survival between SA and REAL; however, CRA was associated with shorter graft survival. Germany performed 76% of all DDRTs after REAL and CRA and the latter mode reduced waiting times by up to 2.9 y. CONCLUSIONS: REAL and CRA are used differently in the ET countries according to national donor rates. Both RA schemes optimize graft utilization, lead to acceptable outcomes, and help to stabilize national DDRT programs, especially in Germany.",

author = "Volker Assfalg and Gregor Miller and Felix Stocker and Norbert H{\"u}ser and Daniel Hartmann and Uwe Heemann and Ineke Tieken and Wouter Zanen and Serge Vogelaar and Rosenkranz, {Alexander R} and Stefan Schneeberger and Reinhold F{\"u}gger and Gabriela Berlakovich and Ysebaert, {Dirk R} and Daniel Jacobs-Tulleneers-Thevissen and Dimitri Mikhalski and {van Laecke}, Steven and Dirk Kuypers and M{\"u}hlfeld, {Anja S} and Richard Viebahn and Johann Pratschke and Sebastian Melchior and Hauser, {Ingeborg A} and Bernd J{\"a}nigen and Rolf Weimer and Nicolas Richter and Susan Foller and Kevin Schulte and Christine Kurschat and Ana Harth and Christian Moench and Sebastian Rademacher and Martin Nitschke and Kr{\"a}mer, {Bernhard K} and Lutz Renders and Dionysios Koliogiannis and Andreas Pascher and Joachim Hoyer and Julia Weinmann-Menke and Mario Schiffer and Bernhard Banas and Oliver Hakenberg and Vedat Schwenger and Silvio Nadalin and Kai Lopau and Laszlo Piros and Balazs Nemes and Peter Szakaly and Antonia Bouts and Bemelman, {Frederike J} and Martinus Christiaans and {Et al.}",

year = "2023",

month = dec,

day = "11",

doi = "10.1097/TP.0000000000004878",

language = "English",

journal = "Transplantation",

issn = "0041-1337",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

}

Assfalg, V, Miller, G, Stocker, F, Hüser, N, Hartmann, D, Heemann, U, Tieken, I, Zanen, W, Vogelaar, S, Rosenkranz, AR, Schneeberger, S, Függer, R, Berlakovich, G, Ysebaert, DR, Jacobs-Tulleneers-Thevissen, D, Mikhalski, D, van Laecke, S, Kuypers, D, Mühlfeld, AS, Viebahn, R, Pratschke, J, Melchior, S, Hauser, IA, Jänigen, B, Weimer, R, Richter, N, Foller, S, Schulte, K, Kurschat, C, Harth, A, Moench, C, Rademacher, S, Nitschke, M, Krämer, BK, Renders, L, Koliogiannis, D, Pascher, A, Hoyer, J, Weinmann-Menke, J, Schiffer, M, Banas, B, Hakenberg, O, Schwenger, V, Nadalin, S, Lopau, K, Piros, L, Nemes, B, Szakaly, P, Bouts, A, Bemelman, FJ, Christiaans, M & Et al. 2023, 'Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation-A Retrospective Multicenter Outcome Analysis', Transplantation. https://doi.org/10.1097/TP.0000000000004878

TY - JOUR

T1 - Rescue Allocation Modes in Eurotransplant Kidney Transplantation

T2 - Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation-A Retrospective Multicenter Outcome Analysis

AU - Assfalg, Volker

AU - Miller, Gregor

AU - Stocker, Felix

AU - Hüser, Norbert

AU - Hartmann, Daniel

AU - Heemann, Uwe

AU - Tieken, Ineke

AU - Zanen, Wouter

AU - Vogelaar, Serge

AU - Rosenkranz, Alexander R

AU - Schneeberger, Stefan

AU - Függer, Reinhold

AU - Berlakovich, Gabriela

AU - Ysebaert, Dirk R

AU - Jacobs-Tulleneers-Thevissen, Daniel

AU - Mikhalski, Dimitri

AU - van Laecke, Steven

AU - Kuypers, Dirk

AU - Mühlfeld, Anja S

AU - Viebahn, Richard

AU - Pratschke, Johann

AU - Melchior, Sebastian

AU - Hauser, Ingeborg A

AU - Jänigen, Bernd

AU - Weimer, Rolf

AU - Richter, Nicolas

AU - Foller, Susan

AU - Schulte, Kevin

AU - Kurschat, Christine

AU - Harth, Ana

AU - Moench, Christian

AU - Rademacher, Sebastian

AU - Nitschke, Martin

AU - Krämer, Bernhard K

AU - Renders, Lutz

AU - Koliogiannis, Dionysios

AU - Pascher, Andreas

AU - Hoyer, Joachim

AU - Weinmann-Menke, Julia

AU - Schiffer, Mario

AU - Banas, Bernhard

AU - Hakenberg, Oliver

AU - Schwenger, Vedat

AU - Nadalin, Silvio

AU - Lopau, Kai

AU - Piros, Laszlo

AU - Nemes, Balazs

AU - Szakaly, Peter

AU - Bouts, Antonia

AU - Bemelman, Frederike J

AU - Christiaans, Martinus

AU - Et al.

PY - 2023/12/11

Y1 - 2023/12/11

N2 - BACKGROUND: Whenever the kidney standard allocation (SA) algorithms according to the Eurotransplant (ET) Kidney Allocation System or the Eurotransplant Senior Program fail, rescue allocation (RA) is initiated. There are 2 procedurally different modes of RA: recipient oriented extended allocation (REAL) and competitive rescue allocation (CRA). The objective of this study was to evaluate the association of patient survival and graft failure with RA mode and whether or not it varied across the different ET countries. METHODS: The ET database was retrospectively analyzed for donor and recipient clinical and demographic characteristics in association with graft outcomes of deceased donor renal transplantation (DDRT) across all ET countries and centers from 2014 to 2021 using Cox proportional hazards methods. RESULTS: Seventeen thousand six hundred seventy-nine renal transplantations were included (SA 15?658 [89%], REAL 860 [4.9%], and CRA 1161 [6.6%]). In CRA, donors were older, cold ischemia times were longer, and HLA matches were worse in comparison with REAL and especially SA. Multivariable analyses showed comparable graft and recipient survival between SA and REAL; however, CRA was associated with shorter graft survival. Germany performed 76% of all DDRTs after REAL and CRA and the latter mode reduced waiting times by up to 2.9 y. CONCLUSIONS: REAL and CRA are used differently in the ET countries according to national donor rates. Both RA schemes optimize graft utilization, lead to acceptable outcomes, and help to stabilize national DDRT programs, especially in Germany.

AB - BACKGROUND: Whenever the kidney standard allocation (SA) algorithms according to the Eurotransplant (ET) Kidney Allocation System or the Eurotransplant Senior Program fail, rescue allocation (RA) is initiated. There are 2 procedurally different modes of RA: recipient oriented extended allocation (REAL) and competitive rescue allocation (CRA). The objective of this study was to evaluate the association of patient survival and graft failure with RA mode and whether or not it varied across the different ET countries. METHODS: The ET database was retrospectively analyzed for donor and recipient clinical and demographic characteristics in association with graft outcomes of deceased donor renal transplantation (DDRT) across all ET countries and centers from 2014 to 2021 using Cox proportional hazards methods. RESULTS: Seventeen thousand six hundred seventy-nine renal transplantations were included (SA 15?658 [89%], REAL 860 [4.9%], and CRA 1161 [6.6%]). In CRA, donors were older, cold ischemia times were longer, and HLA matches were worse in comparison with REAL and especially SA. Multivariable analyses showed comparable graft and recipient survival between SA and REAL; however, CRA was associated with shorter graft survival. Germany performed 76% of all DDRTs after REAL and CRA and the latter mode reduced waiting times by up to 2.9 y. CONCLUSIONS: REAL and CRA are used differently in the ET countries according to national donor rates. Both RA schemes optimize graft utilization, lead to acceptable outcomes, and help to stabilize national DDRT programs, especially in Germany.

U2 - 10.1097/TP.0000000000004878

DO - 10.1097/TP.0000000000004878

M3 - Article

SN - 0041-1337

JO - Transplantation

JF - Transplantation

ER -