title: High-urgency kidney transplantation in the Eurotransplant Kidney Allocation System: success or waste of organs? The Eurotransplant 15-year all-centre survey.
abstract: In the Eurotransplant Kidney Allocation System (ETKAS), transplant candidates can be considered for high-urgency (HU) status in case of life-threatening inability to undergo renal replacement therapy. Data on the outcomes of HU transplantation are sparse and the benefit is controversial.
  
  
  
  We systematically analysed data from 898 ET HU kidney transplant recipients from 61 transplant centres between 1996 and 2010 and investigated the 5-year patient and graft outcomes and differences between relevant subgroups.
  
  
  
  Kidney recipients with an HU status were younger (median 43 versus 55 years) and spent less time on the waiting list compared with non-HU recipients (34 versus 54 months). They received grafts with significantly more mismatches (mean 3.79 versus 2.42; P < 0.001) and the percentage of retransplantations was remarkably higher (37.5 versus 16.7%). Patient survival (P = 0.0053) and death with a functioning graft (DwFG; P < 0.0001) after HU transplantation were significantly worse than in non-HU recipients, whereas graft outcome was comparable (P = 0.094). Analysis according to the different HU indications revealed that recipients listed HU because of an imminent lack of access for dialysis had a significantly worse patient survival (P = 0.0053) and DwFG (P = 0.0462) compared with recipients with psychological problems and suicidality because of dialysis. In addition, retransplantation had a negative impact on patient and graft outcome.
  
  
  
  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.
authors.affiliation: TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Assfalg
authors.affiliation: TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Hüser
authors.affiliation: Eurotransplant International Foundation, NL-2332 CB Leiden, The Netherlands.
authors.forename: Marieke
authors.initials: M
authors.lastname: van Meel
authors.affiliation: Institute for Medical Statistics and Epidemiology (IMSE), Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haller
authors.affiliation: Eurotransplant International Foundation, NL-2332 CB Leiden, The Netherlands.
authors.forename: Axel
authors.initials: A
authors.lastname: Rahmel
authors.affiliation: Eurotransplant International Foundation, NL-2332 CB Leiden, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: de Boer
authors.affiliation: TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany.
authors.forename: Edouard
authors.initials: E
authors.lastname: Matevossian
authors.affiliation: TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Novotny
authors.affiliation: Department of Pediatric Nephrology, University Hospitals Leuven, B-3000 Leuven, Belgium.
authors.forename: Noël
authors.initials: N
authors.lastname: Knops
authors.affiliation: Department of Nephrology, Centre Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman, B-4000 Liège, Belgium.
authors.forename: Laurent
authors.initials: L
authors.lastname: Weekers
authors.affiliation: Department of Surgery, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.affiliation: Department of Surgery, Medizinische Universität Innsbruck, A-6020 Innsbruck, Austria.
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.affiliation: Department of Surgery, Krankenhaus der Elisabethinen Linz GmbH, A-4020 Linz, Austria.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Függer
authors.affiliation: Department of Nephrology, Allgemeines Krankenhaus Linz, A-4021 Linz, Austria.
authors.forename: Otmar
authors.initials: O
authors.lastname: Janko
authors.affiliation: Department of Surgery, Medizinische Universität Wien, AKH Wien, A-1090 Wien, Austria.
authors.forename: Susanne
authors.initials: S
authors.lastname: Rasoul-Rockenschaub
authors.affiliation: Department of Nephrology, Universitair Ziekenhuis Antwerpen, B-2650 Edegem, Belgium.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Bosmans
authors.affiliation: Department of Nephrology, Erasme University Hospital, Université Libre de Bruxelles, B-1070 Bruxelles, Belgium.
authors.forename: Nilufer
authors.initials: N
authors.lastname: Broeders
authors.affiliation: Department of Nephrology, University Hospital Ghent, B-9000 Ghent, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Peeters
authors.affiliation: Department of Surgery, Cliniques universitaires Saint-Luc, Université Catholique de Louvain Brussels, B-1200 Bruxelles, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Mourad
authors.affiliation: Department of Nephrology, University Hospitals Leuven, B-3000 Leuven, Belgium.
authors.forename: Dirk
authors.initials: D
authors.lastname: Kuypers
authors.affiliation: Department of Nephrology, University of Zagreb, School of Medicine, HR-10000 Zagreb, Croatia.
authors.forename: Jasna
authors.initials: J
authors.lastname: Slaviček
authors.affiliation: Department of Nephrology, Uniklinik RWTH Aachen, Klinik für Nieren- und Hochdruckkrankheiten, Rheumatologische und Immunologische Erkrankungen, D-52074 Aachen, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Muehlfeld
authors.affiliation: Department of Surgery, Klinikum Augsburg, D-86156 Augsburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Sommer
authors.affiliation: Department of Surgery, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, D-44892 Bochum, Germany.
authors.forename: Richard
authors.initials: R
authors.lastname: Viebahn
authors.affiliation: Department of Surgery, Charité-Universitätsmedizin Berlin, D-13353 Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pascher
authors.affiliation: Department of Nephrology, Charité-Universitätsmedizin Berlin, D-12200 Berlin, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: van der Giet
authors.affiliation: Department of Urology and Transplantation, Klinikum Bremen-Mitte, D-28205 Bremen, Germany.
authors.forename: Frans
authors.initials: F
authors.lastname: Zantvoort
authors.affiliation: Department of Nephrology, Universitätsklinikum Bonn, D-53127 Bonn, Germany.
authors.forename: Rainer P
authors.initials: RP
authors.lastname: Woitas
authors.affiliation: Department of Urology, Universitätsklinik Carl Gustav Carus, D-01307 Dresden, Germany.
authors.forename: Juliane
authors.initials: J
authors.lastname: Putz
authors.affiliation: Department of Vascular Surgery, Universitätsklinikum Düsseldorf, D-40225 Düsseldorf, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Grabitz
authors.affiliation: Department of Nephrology, Universität Duisburg-Essen, Universitätsklinikum Essen, D-45122 Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kribben
authors.affiliation: Department of Nephrology, Universitätsklinikum Frankfurt, Klinikum der Johann Wolfgang Goethe Universität, Theodor-Stern-Kai, D-60596 Frankfurt/M, Germany.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Hauser
authors.affiliation: Department of Surgery, Universitätsklinikum Freiburg, D-79106 Freiburg, Germany.
authors.forename: Przemyslaw
authors.initials: P
authors.lastname: Pisarski
authors.affiliation: Transplant Center, Universitätsklinikum Gießen und Marburg GmbH, D-35392 Gießen, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Weimer
authors.affiliation: Department of Surgery, Universitätsmedizin Göttingen, Georg-August-Universität, D-37075 Göttingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lorf
authors.affiliation: Department of Urology, Universitätsklinikum Halle, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, D-06120 Halle, Germany.
authors.forename: Paola
authors.initials: P
authors.lastname: Fornara
authors.affiliation: Transplant Center, Universitätsklinikum Heidelberg, D-69120 Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Morath
authors.affiliation: Department of Hepatobiliary and Transplant Surgery, Universitätsklinikum Hamburg-Eppendorf, D-20246 Hamburg, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Nashan
authors.affiliation: Department of Surgery, Medizinische Hochschule Hannover (MHH), D-30625 Hannover, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Lehner
authors.affiliation: Department of Nephrology, Transplantationszentrum Hann. Münden, Nephrologisches Zentrum Niedersachsen, D-34346 Hannoversch Münden, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Kliem
authors.affiliation: Transplant Center Transplantationszentrum des Saarlandes, Universitätsklinikum Homburg, D-66421 Homburg, Germany.
authors.forename: Urban
authors.initials: U
authors.lastname: Sester
authors.affiliation: Department of Urology, Universitätsklinikum Jena, D-07743 Jena, Germany.
authors.forename: Marc-Oliver
authors.initials: MO
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authors.affiliation: Department of Nephrology, Universitätsklinikum Schleswig-Holstein, D-24105 Kiel, Germany.
authors.forename: Thorsten
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authors.lastname: Feldkamp
authors.affiliation: Department of Surgery, Universitätsklinikum Köln, D-50937 Köln, Germany.
authors.forename: Robert
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authors.affiliation: Department of Nephrology, Krankenhaus Köln-Merheim-Klinikum der Universität Witten/Herdecke, D-51109 Köln, Germany.
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authors.affiliation: Department of Surgery, Westpfalz-Klinikum GmbH, D-67655 Kaiserslautern, Germany.
authors.forename: Christian
authors.initials: C
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authors.affiliation: Department of Surgery, Universitätsklinikum Leipzig, D-04103 Leipzig, Germany.
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authors.initials: MB
authors.lastname: Schoenberg
authors.affiliation: Department of Nephrology, Universitätsklinikum Schleswig-Holstein, D-23538 Lübeck, Germany.
authors.forename: Martin
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authors.affiliation: Department of Nephrology, Medizinische Fakultät Mannheim der Universität Heidelberg, D-68167 Mannheim, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Krüger
authors.affiliation: TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Thorban
authors.affiliation: Transplantationszentrum München der Ludwig-Maximilians-Universität Klinikum Großhadern, D-81377 München, Germany.
authors.forename: Helmut P
authors.initials: HP
authors.lastname: Arbogast
authors.affiliation: Department of Surgery, Universitätsklinikum Münster, D-48149 Münster, Germany.
authors.forename: Heiner H
authors.initials: HH
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authors.affiliation: Department of Nephrology, Klinikum der Philipps-Universität Marburg, Baldingerstraße, D-35043 Marburg, Germany.
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authors.affiliation: Department of Nephrology, I. Medizinische Klinik und Poliklinik, Johannes Gutenberg-Universität, D-55131 Mainz, Germany.
authors.forename: Jens
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authors.lastname: Lutz
authors.affiliation: Department of Nephrology, Universitätsklinikum Erlangen, D-91054 Erlangen, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Heller
authors.affiliation: Department of Nephrology, Universitätsklinikum Regensburg, D-93053 Regensburg, Germany.
authors.forename: Bernhard
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authors.lastname: Banas
authors.affiliation: Department of Urology, Universitätsmedizin, D-18055 Rostock, Germany.
authors.forename: Oliver
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authors.affiliation: Transplant Center Klinikum Stuttgart, Katharinenhospital, D-70174 Stuttgart, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Kalus
authors.affiliation: Department of Surgery, Universitätsklinikum Tübingen, D-72076 Tübingen, Germany.
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.affiliation: Department of Nephrology, Universitätsklinikum Ulm, D-89070 Ulm, Germany.
authors.forename: Frieder
authors.initials: F
authors.lastname: Keller
authors.affiliation: Department of Nephrology, Universitätsklinikum Würzburg, D-97080 Würzburg, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Lopau
authors.affiliation: Department of Nephrology, Universiteit van Amsterdam, Amsterdam NL-1105 AZ, The Netherlands.
authors.forename: Frederike José
authors.initials: FJ
authors.lastname: Bemelman
authors.affiliation: Department of Nephrology, VU University Medical Center Amsterdam, Amsterdam NL-1081 HV, The Netherlands.
authors.forename: Shaikh
authors.initials: S
authors.lastname: Nurmohamed
authors.affiliation: Department of Nephrology, Universitair Medisch Centrum Groningen, Groningen NL-9713 GZ, The Netherlands.
authors.forename: Jan-Stephan
authors.initials: JS
authors.lastname: Sanders
authors.affiliation: Department of Nephrology, Leids Universitair Medisch Centrum, Leiden NL-2333 ZA, The Netherlands.
authors.forename: Johan W
authors.initials: JW
authors.lastname: de Fijter
authors.affiliation: Department of Nephrology, Universitair Medisch Centrum Maastricht, Maastricht NL-6229 HX, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Christiaans
authors.affiliation: Department of Nephrology, Radboud Universitair Medisch Centrum Nijmegen, Nijmegen NL-6525 GA, The Netherlands.
authors.forename: Luuk
authors.initials: L
authors.lastname: Hilbrands
authors.affiliation: Department of Nephrology, Erasmus Universitair Medisch Centrum Rotterdam, Rotterdam NL-3015 AA, The Netherlands.
authors.forename: Michiel
authors.initials: M
authors.lastname: Betjes
authors.affiliation: Department of Nephrology, Universitair Medisch Centrum Utrecht, Utrecht NL-3584 CX, The Netherlands.
authors.forename: Arjan
authors.initials: A
authors.lastname: van Zuilen
authors.affiliation: TransplanTUM, Munich Transplant Center, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany Department of Nephrology, Klinikum rechts der Isar der Technischen Universität München, D-81675 Munich, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Heemann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D046148:Donor Selection / Q000592:standards*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012086:Reoperation; D040841:Resource Allocation / Q000592:standards*; D011795:Surveys and Questionnaires; D009927:Tissue and Organ Procurement / Q000592:standards*; D014850:Waiting Lists; D055815:Young Adult
keywords: graft survival; high-urgency; kidney; patient survival; renal; transplantation