Balancing competing needs in kidney transplantation: does an allocation system prioritizing children affect the renal transplant function?

Details

Serval ID
serval:BIB_6CEE0282A458
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Balancing competing needs in kidney transplantation: does an allocation system prioritizing children affect the renal transplant function?
Journal
Transplant international
Author(s)
Weitz M., Sazpinar O., Schmidt M., Neuhaus T.J., Maurer E., Kuehni C., Parvex P., Chehade H., Tschumi S., Immer F., Laube G.F.
ISSN
1432-2277 (Electronic)
ISSN-L
0934-0874
Publication state
Published
Issued date
01/2017
Peer-reviewed
Oui
Volume
30
Number
1
Pages
68-75
Language
english
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
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 m(2) , 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.

Keywords
Adolescent, Adult, Child, Child, Preschool, Creatinine/urine, Female, Glomerular Filtration Rate, Graft Survival, Humans, Kidney Transplantation/methods, Living Donors, Male, Middle Aged, Odds Ratio, Renal Insufficiency/surgery, Retrospective Studies, Tissue and Organ Procurement/methods, Transplants, Treatment Outcome, children, kidney allocation, kidney transplant function, policy analysis
Pubmed
Web of science
Open Access
Yes
Create date
19/10/2016 12:17
Last modification date
20/08/2019 15:26
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