High-urgency kidney transplantation in the Eurotransplant Kidney Allocation System: success or waste of organs? The Eurotransplant 15-year all-centre survey.

Autor:	Assfalg V; TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany., Hüser N; TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany., van Meel M; Eurotransplant International Foundation, NL-2332 CB Leiden, The Netherlands., Haller B; Institute for Medical Statistics and Epidemiology (IMSE), Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany., Rahmel A; Eurotransplant International Foundation, NL-2332 CB Leiden, The Netherlands., de Boer J; Eurotransplant International Foundation, NL-2332 CB Leiden, The Netherlands., Matevossian E; TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany., Novotny A; TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany., Knops N; Department of Pediatric Nephrology, University Hospitals Leuven, B-3000 Leuven, Belgium., Weekers L; Department of Nephrology, Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman, B-4000 Liège, Belgium., Friess H; Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany., Pratschke J; Department of Surgery, Medizinische Universität Innsbruck, A-6020 Innsbruck, Austria., Függer R; Department of Surgery, Krankenhaus der Elisabethinen Linz GmbH, A-4020 Linz, Austria., Janko O; Department of Nephrology, Allgemeines Krankenhaus Linz, A-4021 Linz, Austria., Rasoul-Rockenschaub S; Department of Surgery, Medizinische Universität Wien, AKH Wien, A-1090 Wien, Austria., Bosmans JL; Department of Nephrology, Universitair Ziekenhuis Antwerpen, B-2650 Edegem, Belgium., Broeders N; Department of Nephrology, Erasme University Hospital, Université Libre de Bruxelles, B-1070 Bruxelles, Belgium., Peeters P; Department of Nephrology, University Hospital Ghent, B-9000 Ghent, Belgium., Mourad M; Department of Surgery, Cliniques universitaires Saint-Luc, Université Catholique de Louvain Brussels, B-1200 Bruxelles, Belgium., Kuypers D; Department of Nephrology, University Hospitals Leuven, B-3000 Leuven, Belgium., Slaviček J; Department of Nephrology, University of Zagreb, School of Medicine, HR-10000 Zagreb, Croatia., Muehlfeld A; Department of Nephrology, Uniklinik RWTH Aachen, Klinik für Nieren- und Hochdruckkrankheiten, Rheumatologische und Immunologische Erkrankungen, D-52074 Aachen, Germany., Sommer F; Department of Surgery, Klinikum Augsburg, D-86156 Augsburg, Germany., Viebahn R; Department of Surgery, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, D-44892 Bochum, Germany., Pascher A; Department of Surgery, Charité-Universitätsmedizin Berlin, D-13353 Berlin, Germany., van der Giet M; Department of Nephrology, Charité-Universitätsmedizin Berlin, D-12200 Berlin, Germany., Zantvoort F; Department of Urology and Transplantation, Klinikum Bremen-Mitte, D-28205 Bremen, Germany., Woitas RP; Department of Nephrology, Universitätsklinikum Bonn, D-53127 Bonn, Germany., Putz J; Department of Urology, Universitätsklinik Carl Gustav Carus, D-01307 Dresden, Germany., Grabitz K; Department of Vascular Surgery, Universitätsklinikum Düsseldorf, D-40225 Düsseldorf, Germany., Kribben A; Department of Nephrology, Universität Duisburg-Essen, Universitätsklinikum Essen, D-45122 Essen, Germany., Hauser I; Department of Nephrology, Universitätsklinikum Frankfurt, Klinikum der Johann Wolfgang Goethe Universität, Theodor-Stern-Kai, D-60596 Frankfurt/M, Germany., Pisarski P; Department of Surgery, Universitätsklinikum Freiburg, D-79106 Freiburg, Germany., Weimer R; Transplant Center, Universitätsklinikum Gießen und Marburg GmbH, D-35392 Gießen, Germany., Lorf T; Department of Surgery, Universitätsmedizin Göttingen, Georg-August-Universität, D-37075 Göttingen, Germany., Fornara P; Department of Urology, Universitätsklinikum Halle, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, D-06120 Halle, Germany., Morath C; Transplant Center, Universitätsklinikum Heidelberg, D-69120 Heidelberg, Germany., Nashan B; Department of Hepatobiliary and Transplant Surgery, Universitätsklinikum Hamburg-Eppendorf, D-20246 Hamburg, Germany., Lehner F; Department of Surgery, Medizinische Hochschule Hannover (MHH), D-30625 Hannover, Germany., Kliem V; Department of Nephrology, Transplantationszentrum Hann. Münden, Nephrologisches Zentrum Niedersachsen, D-34346 Hannoversch Münden, Germany., Sester U; Transplant Center Transplantationszentrum des Saarlandes, Universitätsklinikum Homburg, D-66421 Homburg, Germany., Grimm MO; Department of Urology, Universitätsklinikum Jena, D-07743 Jena, Germany., Feldkamp T; Department of Nephrology, Universitätsklinikum Schleswig-Holstein, D-24105 Kiel, Germany., Kleinert R; Department of Surgery, Universitätsklinikum Köln, D-50937 Köln, Germany., Arns W; Department of Nephrology, Krankenhaus Köln-Merheim-Klinikum der Universität Witten/Herdecke, D-51109 Köln, Germany., Mönch C; Department of Surgery, Westpfalz-Klinikum GmbH, D-67655 Kaiserslautern, Germany., Schoenberg MB; Department of Surgery, Universitätsklinikum Leipzig, D-04103 Leipzig, Germany., Nitschke M; Department of Nephrology, Universitätsklinikum Schleswig-Holstein, D-23538 Lübeck, Germany., Krüger B; Department of Nephrology, Medizinische Fakultät Mannheim der Universität Heidelberg, D-68167 Mannheim, Germany., Thorban S; TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany., Arbogast HP; Transplantationszentrum München der Ludwig-Maximilians-Universität Klinikum Großhadern, D-81377 München, Germany., Wolters HH; Department of Surgery, Universitätsklinikum Münster, D-48149 Münster, Germany., Maier T; Department of Nephrology, Klinikum der Philipps-Universität Marburg, Baldingerstraße, D-35043 Marburg, Germany., Lutz J; Department of Nephrology, I. Medizinische Klinik und Poliklinik, Johannes Gutenberg-Universität, D-55131 Mainz, Germany., Heller K; Department of Nephrology, Universitätsklinikum Erlangen, D-91054 Erlangen, Germany., Banas B; Department of Nephrology, Universitätsklinikum Regensburg, D-93053 Regensburg, Germany., Hakenberg O; Department of Urology, Universitätsmedizin, D-18055 Rostock, Germany., Kalus M; Transplant Center Klinikum Stuttgart, Katharinenhospital, D-70174 Stuttgart, Germany., Nadalin S; Department of Surgery, Universitätsklinikum Tübingen, D-72076 Tübingen, Germany., Keller F; Department of Nephrology, Universitätsklinikum Ulm, D-89070 Ulm, Germany., Lopau K; Department of Nephrology, Universitätsklinikum Würzburg, D-97080 Würzburg, Germany., Bemelman FJ; Department of Nephrology, Universiteit van Amsterdam, Amsterdam NL-1105 AZ, The Netherlands., Nurmohamed S; Department of Nephrology, VU University Medical Center Amsterdam, Amsterdam NL-1081 HV, The Netherlands., Sanders JS; Department of Nephrology, Universitair Medisch Centrum Groningen, Groningen NL-9713 GZ, The Netherlands., de Fijter JW; Department of Nephrology, Leids Universitair Medisch Centrum, Leiden NL-2333 ZA, The Netherlands., Christiaans M; Department of Nephrology, Universitair Medisch Centrum Maastricht, Maastricht NL-6229 HX, The Netherlands., Hilbrands L; Department of Nephrology, Radboud Universitair Medisch Centrum Nijmegen, Nijmegen NL-6525 GA, The Netherlands., Betjes M; Department of Nephrology, Erasmus Universitair Medisch Centrum Rotterdam, Rotterdam NL-3015 AA, The Netherlands., van Zuilen A; Department of Nephrology, Universitair Medisch Centrum Utrecht, Utrecht NL-3584 CX, The Netherlands., Heemann U; TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany Department of Nephrology, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany.
Jazyk:	angličtina
Zdroj:	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association [Nephrol Dial Transplant] 2016 Sep; Vol. 31 (9), pp. 1515-22. Date of Electronic Publication: 2016 Feb 04.
DOI:	10.1093/ndt/gfv446
Abstrakt:	Background: In the Eurotransplant Kidney Allocation System (ETKAS), transplant candidates can be considered for high-urgency (HU) status in case of life-threatening inability to undergo renal replacement therapy. Data on the outcomes of HU transplantation are sparse and the benefit is controversial. Methods: We systematically analysed data from 898 ET HU kidney transplant recipients from 61 transplant centres between 1996 and 2010 and investigated the 5-year patient and graft outcomes and differences between relevant subgroups. Results: Kidney recipients with an HU status were younger (median 43 versus 55 years) and spent less time on the waiting list compared with non-HU recipients (34 versus 54 months). They received grafts with significantly more mismatches (mean 3.79 versus 2.42; P < 0.001) and the percentage of retransplantations was remarkably higher (37.5 versus 16.7%). Patient survival (P = 0.0053) and death with a functioning graft (DwFG; P < 0.0001) after HU transplantation were significantly worse than in non-HU recipients, whereas graft outcome was comparable (P = 0.094). Analysis according to the different HU indications revealed that recipients listed HU because of an imminent lack of access for dialysis had a significantly worse patient survival (P = 0.0053) and DwFG (P = 0.0462) compared with recipients with psychological problems and suicidality because of dialysis. In addition, retransplantation had a negative impact on patient and graft outcome. Conclusions: Facing organ shortages, increasing wait times and considerable mortality on dialysis, we question the current policy of HU allocation and propose more restrictive criteria with regard to individuals with vascular complications or repeated retransplantations in order to support patients on the non-HU waiting list with a much better long-term prognosis. (© The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.)
Databáze:	MEDLINE
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