J. Demeester et al., THE NEW EUROTRANSPLANT KIDNEY ALLOCATION SYSTEM - REPORT ONE-YEAR AFTER IMPLEMENTATION, Transplantation, 66(9), 1998, pp. 1154-1159
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.