Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation - A Retrospective Multicenter Outcome Analysis

Assfalg V, Miller G, Stocker F, Hüser N, Hartmann D, Heemann U, Tieken I, Zanen W, Vogelaar S, Rosenkranz AR, Schneeberger S, Függer R, Berlakovich G, Ysebaert DR, Jacobs-Tulleneers-Thevissen D, Mikhalski D, Van Laecke S, Kuypers D, Mühlfeld AS, Viebahn R, Pratschke J, Melchior S, Hauser IA, Jänigen B, Weimer R, Richter N, Foller S, Schulte K, Kurschat C, Harth A, Moench C, Rademacher S, Nitschke M, Krämer BK, Renders L, Koliogiannis D, Pascher A, Hoyer J, Weinmann-Menke J, Schiffer M, Banas B, Hakenberg O, Schwenger V, Nadalin S, Lopau K, Piros L, Nemes B, Szakaly P, Bouts A, Bemelman FJ, Sanders JS, De Vries AP, Christiaans MH, Hilbrands L, Van Zuilen AD, Arnol M, Stippel D, Wahba R (2024)

Publication Type: Journal article

Publication year: 2024


Book Volume: 108

Pages Range: 1200-1211

Journal Issue: 5

DOI: 10.1097/TP.0000000000004878


Background. Whenever the kidney standard allocation (SA) algorithms according to the Eurotransplant (ET) Kidney Allocation System or the Eurotransplant Senior Program fail, rescue allocation (RA) is initiated. There are 2 procedurally different modes of RA: recipient oriented extended allocation (REAL) and competitive rescue allocation (CRA). The objective of this study was to evaluate the association of patient survival and graft failure with RA mode and whether or not it varied across the different ET countries. Methods. The ET database was retrospectively analyzed for donor and recipient clinical and demographic characteristics in association with graft outcomes of deceased donor renal transplantation (DDRT) across all ET countries and centers from 2014 to 2021 using Cox proportional hazards methods. Results. Seventeen thousand six hundred seventy-nine renal transplantations were included (SA 15 658 [89%], REAL 860 [4.9%], and CRA 1161 [6.6%]). In CRA, donors were older, cold ischemia times were longer, and HLA matches were worse in comparison with REAL and especially SA. Multivariable analyses showed comparable graft and recipient survival between SA and REAL; however, CRA was associated with shorter graft survival. Germany performed 76% of all DDRTs after REAL and CRA and the latter mode reduced waiting times by up to 2.9 y. Conclusions. REAL and CRA are used differently in the ET countries according to national donor rates. Both RA schemes optimize graft utilization, lead to acceptable outcomes, and help to stabilize national DDRT programs, especially in Germany.

Authors with CRIS profile

Involved external institutions

Klinikum rechts der Isar DE Germany (DE) Medizinische Universität Graz AT Austria (AT) Universitätsklinikum Köln DE Germany (DE) University of Pécs / Pécsi Tudományegyetem HU Hungary (HU) Academic Medical Centre / Academisch Medisch Centrum (AMC) NL Netherlands (NL) Leiden University Medical Center NL Netherlands (NL) Technische Universität München (TUM) DE Germany (DE) Maastricht University NL Netherlands (NL) Radboud University Nijmegen Medical Centre / Radboudumc of voluit Radboud Universitair Medisch Centrum (UMC) NL Netherlands (NL) University Medical Centre Utrecht (UMC Utrecht) NL Netherlands (NL) Ljubljana University Medical Centre (Ljubljana UMC) / Univerzitetni klinični center Ljubljana SI Slovenia (SI) Universitätsmedizin Rostock DE Germany (DE) Klinikum Stuttgart DE Germany (DE) Universitätsklinikum Tübingen DE Germany (DE) Julius-Maximilians-Universität Würzburg DE Germany (DE) Semmelweis University / Semmelweis Egyetem HU Hungary (HU) Eurotransplant NL Netherlands (NL) Amsterdam University Medical Centers (Amsterdam UMC) / Amsterdam Universitair Medische Centra NL Netherlands (NL) University Medical Center Groningen (UMCG) / Universitair Medisch Centrum Groningen NL Netherlands (NL) Medizinische Universität Innsbruck AT Austria (AT) Johannes Kepler Universität (JKU) Linz AT Austria (AT) Medizinische Universität Wien AT Austria (AT) Hospital Network Antwerp / Ziekenhuis Netwerk Antwerpen (ZNA) BE Belgium (BE) Universitair Ziekenhuis Brussel BE Belgium (BE) Hôpital Erasme BE Belgium (BE) University Hospital Ghent BE Belgium (BE) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven BE Belgium (BE) Universitätsklinikum Aachen (UKA) DE Germany (DE) Universitätsklinikum Knappschaftskrankenhaus Bochum DE Germany (DE) Charité - Universitätsmedizin Berlin DE Germany (DE) Universitätsklinikum Frankfurt am Main (KGU) DE Germany (DE) Universitätsklinikum Freiburg DE Germany (DE) Justus-Liebig-Universität Gießen DE Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School DE Germany (DE) Universitätsklinikum Jena DE Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) DE Germany (DE) Universität Witten/Herdecke DE Germany (DE) Westpfalz-Klinikum DE Germany (DE) Universitätsklinikum Leipzig DE Germany (DE) Universitätsklinikum Mannheim DE Germany (DE) Ludwig-Maximilians-Universität (LMU) DE Germany (DE) Universitätsklinikum Münster DE Germany (DE) Universitätsklinikum Gießen und Marburg (UKGM) DE Germany (DE) Universitätsmedizin der Johannes Gutenberg-Universität Mainz DE Germany (DE) Universitätsklinikum Regensburg DE Germany (DE)

How to cite


Assfalg, V., Miller, G., Stocker, F., Hüser, N., Hartmann, D., Heemann, U.,... Wahba, R. (2024). Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation - A Retrospective Multicenter Outcome Analysis. Transplantation, 108(5), 1200-1211.


Assfalg, Volker, et al. "Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation - A Retrospective Multicenter Outcome Analysis." Transplantation 108.5 (2024): 1200-1211.

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