title: Shipping donor kidneys within Eurotransplant: outcomes after renal transplantation in a single-centre cohort study.
abstract: BACKGROUND
  Shipment of organs during the allocation process aims to improve human leucocyte antigen (HLA) matching but can also have a detrimental effect by prolonging cold ischaemia. The overall effect of organ exchange on post-transplant outcomes in the Eurotransplant (ET) region has not been investigated.
  
  
  METHODS
  This is a retrospective single-centre cohort study to investigate the effect of shipment of renal allografts on cold ischaemia times and the incidence of acute rejection (AR) and graft survival in 661 transplantations of deceased donor kidneys.
  
  
  RESULTS
  Forty-six per cent (N = 301) of the patients received a locally procured and 54% (N = 360) a shipped donor kidney. Locally procured donors tended to be older, more often hypertensive and had less frequently died from trauma. Recipients of shipped kidneys were at higher immunological risk, being younger, more frequently retransplanted and immunized against HLA antigens. Shipped kidneys had a 2.2-h prolongation of cold ischaemia time (18.0 versus 20.2 h; P < 0.0001) but significantly less HLA A, B and DR mismatches (2.20 versus 2.84; P < 0.0001). Recipients of shipped kidneys had an increased incidence of first-year AR [19 versus 13%; odds ratio 1.62 (1.06-2.49); P = 0.026] and death-censored graft loss [hazard ratio 1.6 (1.1-2.4); P = 0.01] that was no longer statistically significant after adjustments for risk factors by multivariable modelling.
  
  
  CONCLUSIONS
  Shipment of kidneys in the ET region is associated with a modest increase in cold ischaemia time and significantly better HLA matching. This allows for successful transplantation of higher risk patients with no significant penalty with regard to AR rates or death-censored graft survival.
authors.affiliation: Renal Transplantation Clinic, Department of Nephrology, ULB Hopital Erasme, Brussels, Belgium. wissing@ulb.ac.be
authors.forename: Karl Martin
authors.initials: KM
authors.lastname: Wissing
authors.forename: Nilufer
authors.initials: N
authors.lastname: Broeders
authors.forename: Annick
authors.initials: A
authors.lastname: Massart
authors.forename: Mireille
authors.initials: M
authors.lastname: Kianda
authors.forename: Lidia
authors.initials: L
authors.lastname: Ghisdal
authors.forename: Anne
authors.initials: A
authors.lastname: Lemy
authors.forename: Anh Dung
authors.initials: AD
authors.lastname: Hoang
authors.forename: Dimitri
authors.initials: D
authors.lastname: Mikhalski
authors.forename: Vincent
authors.initials: V
authors.lastname: Donckier
authors.forename: Judith
authors.initials: J
authors.lastname: Racapé
authors.forename: Pierre
authors.initials: P
authors.lastname: Vereerstraeten
authors.forename: Jan
authors.initials: J
authors.lastname: de Boer
authors.forename: Daniel
authors.initials: D
authors.lastname: Abramowicz
mesh_terms: D000328:Adult; D050377:Cold Ischemia; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000453:epidemiology / Q000401:mortality*; D006085:Graft Survival; D006680:HLA Antigens / Q000032:analysis; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014186:Transportation
chemical_list: D006680:HLA Antigens