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

Assfalg V, Miller G, Stocker F, Van Meel M, Groenevelt T, Tieken I, Ankerst D, Renders L, Novotny A, Hartmann D, Jell A, Rahmel A, Wahba R, Muehlfeld A, Bouts A, Ysebaert D, Globke B, Jacobs-Tulleneers-Thevissen D, Piros L, Stippel D, Heller KM, Eisenberger U, Van Laecke S, Weimer R, Rosenkranz AR, Berger S, Fischer L, Kliem V, Vondran F, Sester U, Schneeberger S, Harth A, Kuypers D, Fuegger R, Arnol M, Christiaans M, Weinmann-Menke J, Krueger B, Hilbrands L, Banas B, Hakenberg O, Minnee R, Schwenger V, Heyne N, Van Zuilen A, Reindl-Schwaighofer R, Lopau K, Hueser N, Heemann U (2022)

Publication Type: Journal article

Publication year: 2022


Book Volume: 106

Pages Range: 1215-1226

Journal Issue: 6

DOI: 10.1097/TP.0000000000003964


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 were performed with graft outcomes for 2422 recipients of a deceased donor renal transplantation (DDRT) after RA versus 25 481 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 versus ETKAS (2.7% versus 10.4%). RA recipients and donors were older compared with SA recipients and donors, cold ischemia times were longer, waiting times were shorter, and the incidence of primary nonfunction was comparable. Among ETKAS recipients, HLA matching was more favorable in SA (mean 3.7 versus 2.5). In multivariate modeling, the incidence of graft loss in ETKAS recipients was reduced in RA compared with SA (subdistribution hazard ratio, 0.80; 95% confidence interval [0.70-0.91], P < 0.001), whereas other outcomes (mortality, death with functioning graft (DwFG)) were not significantly different. None of the 3 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.

Involved external institutions

Universitätsklinikum Aachen (UKA) DE Germany (DE) Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra NL Netherlands (NL) Technische Universität München (TUM) DE Germany (DE) Eurotransplant NL Netherlands (NL) Universität zu Köln DE Germany (DE) Universitätsklinikum Würzburg DE Germany (DE) Medizinische Universität Wien AT Austria (AT) Charité - Universitätsmedizin Berlin DE Germany (DE) University Medical Centre Utrecht (UMC Utrecht) NL Netherlands (NL) Antwerp University Hospital BE Belgium (BE) Ruprecht-Karls-Universität Heidelberg DE Germany (DE) Universitätsklinikum des Saarlandes (UKS) DE Germany (DE) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven BE Belgium (BE) Katharinenhospital Stuttgart DE Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) DE Germany (DE) Universitätsklinikum Regensburg DE Germany (DE) Nierentransplantationszentrum - Klinikum Hann. Münden DE Germany (DE) Radboud University Nijmegen Medical Centre / Radboudumc of voluit Radboud Universitair Medisch Centrum (UMC) NL Netherlands (NL) Medizinische Universität Innsbruck AT Austria (AT) Maastricht University NL Netherlands (NL) Universitätsklinikum Gießen und Marburg (UKGM) DE Germany (DE) University of Groningen / Rijksuniversiteit Groningen NL Netherlands (NL) Ljubljana University Medical Centre (Ljubljana UMC) / Univerzitetni klinični center Ljubljana SI Slovenia (SI) Semmelweis University / Semmelweis Egyetem HU Hungary (HU) Krankenhaus Köln-Merheim - Klinikum der Universität Witten/Herdecke DE Germany (DE) Ordensklinikum Linz - Elisabethinen AT Austria (AT) Erasmus University Medical Center (MC) NL Netherlands (NL) Johannes Gutenberg-Universität Mainz (JGU) DE Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School DE Germany (DE) Vrije Universiteit Brussel (VUB) BE Belgium (BE) Universität Duisburg-Essen (UDE) DE Germany (DE) University Hospital Ghent BE Belgium (BE) Universitätsmedizin Rostock DE Germany (DE) Universitätsklinikum Tübingen DE Germany (DE)

How to cite


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.


Assfalg, Volker, et al. "Kidney Transplantation After Rescue Allocation-the Eurotransplant Experience: A Retrospective Multicenter Outcome Analysis." Transplantation 106.6 (2022): 1215-1226.

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