title: Balancing competing needs in kidney transplantation: does an allocation system prioritizing children affect the renal transplant function?
abstract: Children often merit priority in access to deceased donor kidneys by organ-sharing organizations. We report the impact of the new Swiss Organ Allocation System (SOAS) introduced in 2007, offering all kidney allografts from deceased donors <60 years preferentially to children. The retrospective cohort study included all paediatric transplant patients (<20 years of age) before (n = 19) and after (n = 32) the new SOAS (from 2001 to 2014). Estimated glomerular filtration rate (eGFR), urine protein-to-creatinine ratio (UPC), need for antihypertensive medication, waiting times to kidney transplantation (KTX), number of pre-emptive transplantations and rejections, and the proportion of living donor transplants were considered as outcome parameters. Patients after the new SOAS had significantly better eGFRs 2 years after KTX (Mean Difference, MD = 25.7 ml/min/1.73 m2, P = 0.025), lower UPC ratios (Median Difference, MeD = -14.5 g/mol, P = 0.004), decreased waiting times to KTX (MeD = -97 days, P = 0.021) and a higher proportion of pre-emptive transplantations (Odds Ratio = 9.4, 95% CI = 1.1-80.3, P = 0.018), while the need for antihypertensive medication, number of rejections and living donor transplantations remained stable. The new SOAS is associated with improved short-term clinical outcomes and more rapid access to KTX. Despite lacking long-term research, the study results should encourage other policy makers to adopt the SOAS approach.
authors.affiliation: University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Marcus
authors.initials: M
authors.lastname: Weitz
authors.affiliation: University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Onur
authors.initials: O
authors.lastname: Sazpinar
authors.affiliation: University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Maria
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Children's Hospital, Lucerne, Switzerland.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Neuhaus
authors.affiliation: Institute for Social and Preventive Medicine, Berne, Switzerland.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Maurer
authors.affiliation: Institute for Social and Preventive Medicine, Berne, Switzerland.
authors.forename: Claudia
authors.initials: C
authors.lastname: Kuehni
authors.affiliation: University Children's Hospital, Geneva, Switzerland.
authors.forename: Paloma
authors.initials: P
authors.lastname: Parvex
authors.affiliation: University Children's Hospital, Lausanne, Switzerland.
authors.forename: Hassib
authors.initials: H
authors.lastname: Chehade
authors.affiliation: University Children's Hospital, Berne, Switzerland.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Tschumi
authors.affiliation: Swisstransplant, Berne, Switzerland.
authors.forename: Franz
authors.initials: F
authors.lastname: Immer
authors.affiliation: University Children's Hospital Zurich, Zurich, Switzerland.
authors.forename: Guido F
authors.initials: GF
authors.lastname: Laube
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D051437:Renal Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement / Q000379:methods*; D019737:Transplants; D016896:Treatment Outcome
chemical_list: D003404:Creatinine
keywords: children; kidney allocation; kidney transplant function; policy analysis