Kidney Transplantation After Rescue Allocation-the Eurotransplant Experience: A Retrospective Multicenter Outcome...

Area of Science:

• Nephrology
• Transplantation
• Public Health

Background:

• Kidney transplants at Eurotransplant are allocated via standard (SA) or rescue allocation (RA) when SA algorithms fail.
• Rescue allocation (RA) is a critical pathway for deceased donor renal transplantation (DDRT).

Purpose of the Study:

• To analyze the outcomes of deceased donor renal transplantation (DDRT) following rescue allocation (RA) compared to standard allocation (SA).

Main Methods:

• Retrospective analysis of 2422 RA recipients versus 25,481 SA recipients from 2006-2018 across 71 Eurotransplant centers.
• Graft outcomes were analyzed based on patient and donor characteristics, cold ischemia times, waiting times, HLA matching, graft loss, mortality, and death with functioning graft (DwFG).

Main Results:

• Rescue allocation (RA) use increased over time, particularly in Germany.
• RA recipients and donors were older, with longer cold ischemia times but shorter waiting times compared to SA.
• Multivariate analysis showed reduced graft loss in RA recipients within the Eurotransplant Kidney Allocation System (ETKAS) (SHR 0.80; P < 0.001), with no significant differences in mortality or death with functioning graft.

Conclusions:

• Despite challenges like older donor/recipient age and longer cold ischemia, rescue allocation (RA) demonstrates positive outcomes, including reduced graft loss in ETKAS.
• The findings support expanding RA to more patients, offering a vital alternative to mitigate risks associated with prolonged dialysis due to donor shortages.