Kidney Transplantation After Rescue Allocation-the Eurotransplant Experience: A Retrospective Multicenter Outcome Analysis.
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Assfalg Volker, Miller Gregor, Stocker Felix, van Meel Marieke, Groenevelt Tiny, Tieken Ineke, Ankerst Donna, Renders Lutz, Novotny Alexander, Hartmann Daniel, Jell Alissa, Rahmel Axel, Wahba Roger, Mühlfeld Anja, Bouts Antonia, Ysebaert Dirk, Globke Brigitta, Jacobs-Tulleneers-Thevissen Daniel, Piros László, Stippel Dirk, Heller Katharina, Eisenberger Ute, van Laecke Steven, Weimer Rolf, Rosenkranz Alexander R, Berger Stefan, Fischer Lutz, Kliem Volker, Vondran Florian, Sester Urban, Schneeberger Stefan, Harth Ana, Kuypers Dirk, Függer Reinhold, Arnol Miha, Christiaans Maarten, Weinmann-Menke Julia, Krüger Bernd, Hilbrands Luuk, Banas Bernhard, Hakenberg Oliver, Minnee Robert, Schwenger Vedat, Heyne Nils, van Zuilen Arjan, Reindl-Schwaighofer Roman, Lopau Kai, Hüser Norbert, Heemann Uwe
Аннотация
METHODS: Retrospective patient clinical and demographic characteristics association analyses were performed with graft outcomes for 2422 recipients of a deceased donor renal transplantation (DDRT) after RA versus 25 481 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 versus ETKAS (2.7% versus 10.4%). RA recipients and donors were older compared with SA recipients and donors, cold ischemia times were longer, waiting times were shorter, and the incidence of primary nonfunction was comparable. Among ETKAS recipients, HLA matching was more favorable in SA (mean 3.7 versus 2.5). In multivariate modeling, the incidence of graft loss in ETKAS recipients was reduced in RA compared with SA (subdistribution hazard ratio, 0.80; 95% confidence interval [0.70-0.91], P < 0.001), whereas other outcomes (mortality, death with functioning graft (DwFG)) were not significantly different. None of the 3 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.