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Analysis of the Eurotransplant Kidney Allocation Algorithm: How Should We Balance Utility and Equity?
K Schulte1, V Klasen1, C Vollmer1
1Clinic for Nephrology and Hypertension, Christian-Albrechts University, Kiel, Germany.
Transplantation Proceedings
|December 23, 2018
Summary
The Eurotransplant kidney allocation algorithm poorly matches predicted survival, unlike the U.S. system. Improving donor-recipient age matching could enhance organ utility in kidney transplantation.
Area of Science:
- Nephrology
- Transplantation Immunology
- Public Health Policy
Background:
- The U.S. kidney allocation system uses the Kidney Donor Profile Index (KDPI) and Estimated Posttransplant Survival Score (EPTS) to match donor and recipient survival since 2014.
- The Eurotransplant (ET) region has its own kidney allocation algorithm, and its effectiveness in promoting organ utility requires evaluation.
- This study investigates the applicability of U.S. allocation scores in the ET region and assesses the ET algorithm's utility promotion.
Purpose of the Study:
- To evaluate the transferability of U.S. kidney allocation scores (KDPI and EPTS) to the Eurotransplant region.
- To determine the extent to which the Eurotransplant kidney allocation algorithm optimizes organ utility.
- To identify factors influencing posttransplant graft and recipient survival within the Eurotransplant system.
Main Methods:
- Analysis of 262 kidney transplantations at University Hospital Kiel (2000-2009) with a median follow-up of 9.94 years.
- Multivariable Cox regression analysis to identify significant predictors of posttransplant survival.
- Correlation analysis between donor/recipient age and KDPI/EPTS within the ET kidney allocation system and European Senior Program.
Main Results:
- Donor age (KDPI) and recipient age (EPTS) were significant predictors of posttransplant survival.
- Other variables showed no additional predictive value beyond age.
- Weak correlations were found between donor/recipient age (r=0.5) and KDPI/EPTS (r=0.4) in the overall ET system, but no correlation when programs were analyzed separately.
Conclusions:
- The ET kidney allocation algorithm demonstrated poor matching of predicted graft and recipient survival at the studied center.
- Improving age-matching between donors and recipients may enhance organ utility in kidney transplantation.
- The findings suggest a need for refinement of the ET allocation algorithm to improve transplant outcomes.
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