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

Abstract

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.

Clinical Characteristics and Outcomes of Kidney Transplantation under Urgency Priority Condition

“…Worse outcomes in UP KT patients were consistently previously reported [2,4,7,8]. In our cohort, UP status was as independent risk factor for graft loss, which should be related to vascular status, since onethird of graft losses occurred due to vascular thrombosis.…”

“…We speculate that this high prevalence is a consequence of the inadequate access to health systems, low-quality vascular accesses for long periods (short or long term dialysis catheters), low access to PD and long period on dialysis off WL. Unlike reported in a European cohort, in which most patients were put on priority list after short period of time on WL, our patients remained a long period of time on dialysis until obtain UP status [7]. This suggests that individual predisposition for vascular failure did not justify the majority of cases, and this condition was a matter of long-term dialysis leading to veins exhaustion.…”

“…Given the above considerations, we understand that it is not possible to compare the prevalence of UP KT in this cohort with reports from other regions whose allocation criteria and socio-demographic profile are different: 0.019% in Turkey [2], 0.96% in Colone, Germany [8], 1.1% in Hanover, Germany [4], 1.7% in Porto, Portugal [6], 2.1% in Eurotransplant area [7], and 3.2% in Rio Grande do Sul, Brazil [3]. We speculate that this high prevalence is a consequence of the inadequate access to health systems, low-quality vascular accesses for long periods (short or long term dialysis catheters), low access to PD and long period on dialysis off WL.…”

“…Despite sensitization, the time for KT after been on WL was relatively short, but the time gap from the onset of dialysis to WL registration was prohibitive, indicating the need for better local policies for early referral for transplantation. The shortage of organs for transplantation and the consistently described poor results of UP KT have led some authors to propose a discussion on this strategy, and question whether this is a heroic attempt or a superfluous procedure, leading to the wastage of organs [7,16]. However, with available evidences, it is not possible to conclude on the "risk-benefit" of this transplant.…”

“…The largest published cohort included 898 patients from 61 centers in the Eutrotransplant area. Results showed that patients transplanted under high-urgency status presented worse survival rates [7]. However, European data cannot be extrapolated to regions where allocation rules, prioritization policies, demographic characteristics, and socioeconomic aspects are distinct.…”