Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation—A Retrospective Multicenter Outcome Analysis-Reference-Cited by-同舟云学术

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

Published:2023-12-11 Issue: Volume: Page:
ISSN:0041-1337
Container-title:Transplantation
language:en
Short-container-title:

Author:

Assfalg Volker¹²,Miller Gregor³,Stocker Felix¹²,Hüser Norbert¹²,Hartmann Daniel¹²,Heemann Uwe¹⁴,Tieken Ineke⁵,Zanen Wouter⁵,Vogelaar Serge⁵,Rosenkranz Alexander R.⁶,Schneeberger Stefan⁷,Függer Reinhold⁸,Berlakovich Gabriela⁹,Ysebaert Dirk R.¹⁰,Jacobs-Tulleneers-Thevissen Daniel¹¹,Mikhalski Dimitri¹²,van Laecke Steven¹³,Kuypers Dirk¹⁴,Mühlfeld Anja S.¹⁵,Viebahn Richard¹⁶,Pratschke Johann¹⁷,Melchior Sebastian¹⁸,Hauser Ingeborg A.¹⁹,Jänigen Bernd²⁰,Weimer Rolf²¹,Richter Nicolas²²,Foller Susan²³,Schulte Kevin²⁴,Kurschat Christine²⁵,Harth Ana²⁶,Moench Christian²⁷,Rademacher Sebastian²⁸,Nitschke Martin²⁹,Krämer Bernhard K.³⁰,Renders Lutz¹⁴,Koliogiannis Dionysios³¹,Pascher Andreas³²,Hoyer Joachim³³,Weinmann-Menke Julia³⁴,Schiffer Mario³⁵,Banas Bernhard³⁶,Hakenberg Oliver³⁷,Schwenger Vedat³⁸,Nadalin Silvio³⁹,Lopau Kai⁴⁰,Piros Laszlo⁴¹,Nemes Balazs⁴²,Szakaly Peter⁴³,Bouts Antonia⁴⁴,Bemelman Frederike J.⁴⁵,Sanders Jan S.⁴⁶,de Vries Aiko P. J.⁴⁷,Christiaans Maarten H. L.⁴⁸,Hilbrands Luuk⁴⁹,van Zuilen Arjan D.⁵⁰,Arnol Miha⁵¹,Stippel Dirk⁵²,Wahba Roger⁵²

Affiliation:

1. TransplanTUM Munich Transplant Center, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany.

2. Department of Surgery, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, Munich, Germany.

3. Department of Mathematics, Technical University of Munich, Garching, Germany.

4. Department of Nephrology, Technical University of Munich, TUM School of Medicine, Klinikum rechts der Isar, München, Germany.

5. Eurotransplant International Foundation, Leiden, the Netherlands.

6. Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria.

7. Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria.

8. Department of Surgery, Krankenhaus der Elisabethinen and Johannes Kepler University, Linz, Austria.

9. Division of Transplantation, Medical University of Vienna, Vienna, Austria.

10. Department of HPB and Transplantation Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.

11. Department of Surgery, Universitair Ziekenhuis Brussel and Vrije Universiteit Brussel, Jette, Belgium.

12. Department of Abdominal Surgery and Transplantation, Hôpital Erasme, ULB, Brussels, Belgium.

13. Renal Department, Universitair Ziekenhuis Gent, Ghent, Belgium.

14. Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium.

15. Department of Nephrology, Uniklinik RWTH Aachen, Aachen, Germany.

16. Chirurgische Klinik, Universitätsklinikum Knappschaftskrankenhaus, Bochum, Germany.

17. Chirurgische Klinik CCM/CVK, Charité Universitätsmedizin Berlin, Berlin, Germany.

18. Department of Urology/Transplantation Center, Bremen, Germany.

19. Department of Nephrology, University Clinic Frankfurt, Frankfurt am Main, Germany.

20. Department of General and Digestive Surgery, Transplant Unit, Freiburg, Germany.

21. Department of Internal Medicine, Nephrology/Renal Transplantation, University of Giessen, Giessen, Germany.

22. Medizinische Hochschule Hannover, Allgemein-, Viszeral- und Transplantationschirurgie, Hannover, Germany.

23. Department of Urology, Jena University Hospital, Jena, Germany.

24. Department of Nephrology and Hypertensiology, University Hospital Schleswig-Holstein, Kiel, Germany.

25. Department II of Internal Medicine and Cologne Excellence Cluster on Cellular Stress Responses in Ageing-Associated Diseases (CECAD), University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.

26. Medizinische Klinik I Merheim, Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Germany.

27. General-, Visceral- and Transplantation Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany.

28. Department of Visceral, Transplantation, Thoracic Surgery, University Hospital Leipzig, Leipzig, Germany.

29. Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.

30. Vth Department of Medicine, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.

31. Department of General, Visceral, and Transplant Surgery, LMU University of Munich, Munich, Germany.

32. Department of General, Visceral, and Transplant Surgery, UKM Muenster, Münster, Germany.

33. Department of Internal Medicine and Nephrology, University Medical Center, Philipps University Marburg, Marburg, Germany.

34. I. Department of Medicine, Division of Nephrology, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.

35. Nephrology and Hypertension, Friedrich-Alexander-University Erlangen, Erlangen, Germany.

36. Abteilung für Nephrologie, Universitäres Transplantationszentrum, Universitätsklinikum Regensburg, Regensburg, Germany.

37. Department of Urology, Rostock University Medical Centre, Rostock, Germany.

38. Department of Nephrology and Transplant Center, Klinikum Stuttgart, Stuttgart, Germany.

39. Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany.

40. Department of Internal Medicine, Division of Nephrology, University of Wuerzburg—Kidney Transplant Program, Wuerzburg, Germany.

41. Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary.

42. Department of Organ Transplantation, Institute of Surgery, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.

43. Department of Surgery, Medical School, University of Pécs, Pécs, Hungary.

44. Pediatric Nephrology Department, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands.

45. Department of Nephrology, Amsterdam University Medical Center, Amsterdam, the Netherlands.

46. Departement of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

47. Department of Medicine, Division of Nephrology, Leiden University Medical Center and Transplant Center, Leiden, the Netherlands.

48. Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Centre, Maastricht, the Netherlands.

49. Department of Nephrology, Radboud University Medical Center, Nijmegen, the Netherlands.

50. Department of Nephrology and Hypertension, UMC Utrecht, Utrecht, the Netherlands.

51. Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia.

52. Department of Surgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Transplantation

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