Assfalg Volker, Hüser Norbert, van Meel Marieke, Haller Bernhard, Rahmel Axel, de Boer Jan, Matevossian Edouard, Novotny Alexander, Knops Noël, Weekers Laurent, Friess Helmut, Pratschke Johann, Függer Reinhold, Janko Otmar, Rasoul-Rockenschaub Susanne, Bosmans Jean-Louis, Broeders Nilufer, Peeters Patrick, Mourad Michel, Kuypers Dirk, Slaviček Jasna, Muehlfeld Anja, Sommer Florian, Viebahn Richard, Pascher Andreas, van der Giet Markus, Zantvoort Frans, Woitas Rainer P, Putz Juliane, Grabitz Klaus, Kribben Andreas, Hauser Ingeborg, Pisarski Przemyslaw, Weimer Rolf, Lorf Thomas, Fornara Paola, Morath Christian, Nashan Björn, Lehner Frank, Kliem Volker, Sester Urban, Grimm Marc-Oliver, Feldkamp Thorsten, Kleinert Robert, Arns Wolfgang, Mönch Christian, Schoenberg Markus Bo, Nitschke Martin, Krüger Bernd, Thorban Stefan, Arbogast Helmut P, Wolters Heiner H, Maier Tanja, Lutz Jens, Heller Katharina, Banas Bernhard, Hakenberg Oliver, Kalus Martin, Nadalin Silvio, Keller Frieder, Lopau Kai, Bemelman Frederike José, Nurmohamed Shaikh, Sanders Jan-Stephan, de Fijter Johan W, Christiaans Maarten, Hilbrands Luuk, Betjes Michiel, van Zuilen Arjan, Heemann Uwe
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.
Eurotransplant International Foundation, NL-2332 CB Leiden, The Netherlands.
Nephrol Dial Transplant. 2016 Sep;31(9):1515-22. doi: 10.1093/ndt/gfv446. Epub 2016 Feb 4.
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.
在欧洲移植肾脏分配系统（ETKAS）中，对于面临危及生命而无法接受肾脏替代治疗的移植候选人，可考虑给予高紧急度（HU）状态。关于HU移植结局的数据稀少，其益处存在争议。
我们系统分析了1996年至2010年间来自61个移植中心的898例ET HU肾脏移植受者的数据，并研究了5年的患者和移植物结局以及相关亚组之间的差异。
与非HU受者相比，处于HU状态的肾脏受者更年轻（中位年龄43岁对55岁），在等待名单上花费的时间更少（34个月对54个月）。他们接受的移植物错配明显更多（平均3.79对2.42；P < 0.001），再次移植的比例显著更高（37.5%对16.7%）。HU移植后的患者生存率（P = 0.0053）和移植物功能存活期死亡（DwFG；P < 0.0001）明显比非HU受者差，而移植物结局相当（P = 0.094）。根据不同的HU适应证进行分析发现，因即将无法进行透析而被列为HU的受者与因透析出现心理问题和自杀倾向的受者相比，患者生存率（P = 0.0053）和DwFG（P = 0.0462）明显更差。此外，再次移植对患者和移植物结局有负面影响。
面对器官短缺、等待时间延长以及透析患者的高死亡率，我们对当前的HU分配政策提出质疑，并建议对有血管并发症或反复再次移植的个体采用更严格的标准，以便支持非HU等待名单上具有更好长期预后的患者。
