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Kidney transplantation after rescue allocation : the Eurotransplant experience : a retrospective multicenter outcome analysis

(2022) TRANSPLANTATION. 106(6). p.1215-1226
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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

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MLA
Assfalg, V., et al. “Kidney Transplantation after Rescue Allocation : The Eurotransplant Experience : A Retrospective Multicenter Outcome Analysis.” TRANSPLANTATION, vol. 106, no. 6, 2022, pp. 1215–26, doi:10.1097/TP.0000000000003964.
APA
Assfalg, V., Miller, G., Stocker, F., Van Meel, M., Groenevelt, T., Tieken, I., … 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
Chicago author-date
Assfalg, V, G Miller, F Stocker, M Van Meel, T Groenevelt, I Tieken, D Ankerst, et al. 2022. “Kidney Transplantation after Rescue Allocation : The Eurotransplant Experience : A Retrospective Multicenter Outcome Analysis.” TRANSPLANTATION 106 (6): 1215–26. https://doi.org/10.1097/TP.0000000000003964.
Chicago author-date (all authors)
Assfalg, V, G Miller, F Stocker, M Van Meel, T Groenevelt, I Tieken, D Ankerst, L Renders, A Novotny, D Hartmann, A Jell, A Rahmel, R Wabba, A Muehlfeld, A Bouts, D ysebaert, B Globke, D Jacobs-Tulleneers-Thevissen, L Piros, D Stippel, K Heller, U Eisenberger, Steven Van Laecke, R Weimer, AR Rosenkranz, S Berger, L Fischer, V Kliem, F Vondran, U Sester, S Schneeberger, A Harth, D Kypers, R Függer, L Hilbrands, B Banas, O Hakenberg, R Minnee, V Schwenger, N Heyne, A van Zuilen, R Reindl-Schwaighofer, K Lopau, N Huüser, and U Heemann. 2022. “Kidney Transplantation after Rescue Allocation : The Eurotransplant Experience : A Retrospective Multicenter Outcome Analysis.” TRANSPLANTATION 106 (6): 1215–1226. doi:10.1097/TP.0000000000003964.
Vancouver
1.
Assfalg V, Miller G, Stocker F, Van Meel M, Groenevelt T, Tieken I, et al. Kidney transplantation after rescue allocation : the Eurotransplant experience : a retrospective multicenter outcome analysis. TRANSPLANTATION. 2022;106(6):1215–26.
IEEE
[1]
V. Assfalg et al., “Kidney transplantation after rescue allocation : the Eurotransplant experience : a retrospective multicenter outcome analysis,” TRANSPLANTATION, vol. 106, no. 6, pp. 1215–1226, 2022.
@article{8741169,
  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.}},
  author       = {{Assfalg, V and Miller, G and Stocker, F and Van Meel, M and Groenevelt, T and Tieken, I and Ankerst, D and Renders, L and Novotny, A and Hartmann, D and Jell, A and Rahmel, A and Wabba, R and Muehlfeld, A and Bouts, A and ysebaert, D and Globke, B and Jacobs-Tulleneers-Thevissen, D and Piros, L and Stippel, D and Heller, K and Eisenberger, U and Van Laecke, Steven and Weimer, R and Rosenkranz, AR and Berger, S and Fischer, L and Kliem, V and Vondran, F and Sester, U and Schneeberger, S and Harth, A and Kypers, D and Függer, R and Hilbrands, L and Banas, B and Hakenberg, O and Minnee, R and Schwenger, V and Heyne, N and van Zuilen, A and Reindl-Schwaighofer, R and Lopau, K and Huüser, N and Heemann, U}},
  issn         = {{0041-1337}},
  journal      = {{TRANSPLANTATION}},
  keywords     = {{COLD ISCHEMIA TIME,GRAFT FAILURE,MORTALITY,RECIPIENTS,RISK,FRAILTY,ASSOCIATION,PREDICTOR,SURVIVAL,DIALYSIS}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{1215--1226}},
  title        = {{Kidney transplantation after rescue allocation : the Eurotransplant experience : a retrospective multicenter outcome analysis}},
  url          = {{http://doi.org/10.1097/TP.0000000000003964}},
  volume       = {{106}},
  year         = {{2022}},
}

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