THE NEW EUROTRANSPLANT KIDNEY ALLOCATION SYSTEM - REPORT ONE-YEAR AFTER IMPLEMENTATION

Citation
J. Demeester et al., THE NEW EUROTRANSPLANT KIDNEY ALLOCATION SYSTEM - REPORT ONE-YEAR AFTER IMPLEMENTATION, Transplantation, 66(9), 1998, pp. 1154-1159
Citations number
11
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Transplantation,Surgery,Immunology
Journal title
ISSN journal
0041-1337
Volume
66
Issue
9
Year of publication
1998
Pages
1154 - 1159
Database
ISI
SICI code
0041-1337(1998)66:9<1154:TNEKAS>2.0.ZU;2-#
Abstract
Background. Upon the availability of a cadaveric donor kidney, a delic ate allocation process precedes every transplantation, A remodeled Eur otransplant Kidney Allocation System (ETKAS)-derived from simulation s tudies-was installed in March 1996. The purpose was to adjust long wai ting times and international exchange balances, while aiming at an opt imal HLA-mismatch distribution. The new ETKAS consisted of a point-sco re system that was 100% patient oriented. Methods. The impact of the n ew ETKAS on the composition of the waiting list, and the outcome of th e allocation procedures during its first year, were evaluated and comp ared with the results obtained in 1995. Results. The percentage of lon g-waiting patients and of patients with poorly matchable HLA phenotype increased significantly, from 9% to 19% and from 19% to 29%, respecti vely, Zero HLA-A-, HLA-B-, HLA-DR-mismatched patients still comprised 23% of the kidney transplant activity. The kidney exchange of the diff erent Eurotransplant countries became balanced within 4 months; this p ersisted during the rest of the year. Pediatric patients had a high tr ansplantation rate due to an assignment of extra points. The compositi on of the waiting list showed, after 1 year, fewer long-waiting patien ts and fewer patients with rare HLA phenotypes. Conclusions. The new E TKAS was able in its first year to meet the goals see at its introduct ion. In comparison with the old ETKAS, there was a better tradeoff bet ween HLA matching and waiting time. The value of computer simulation s tudies has been demonstrated impressively in the context of organ allo cation.