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

Authors
Weitz, Marcus
Sazpinar, Onur
Schmidt, Maria
Neuhaus, Thomas J
Maurer, Elisabeth
Kuehni, Claudia
Chehade, Hassib
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Published in Transplant International. 2017, vol. 30, no. 1, p. 68-75
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.
Keywords AdolescentAdultChildChildPreschoolCreatinine/urineFemaleGlomerular Filtration RateGraft SurvivalHumansKidney Transplantation/methodsLiving DonorsMaleMiddle AgedOdds RatioRenal Insufficiency/surgeryRetrospective StudiesTissue and Organ Procurement/methodsTransplantsTreatment Outcome
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PMID: 27732754
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WEITZ, Marcus et al. Balancing competing needs in kidney transplantation: does an allocation system prioritizing children affect the renal transplant function?. In: Transplant International, 2017, vol. 30, n° 1, p. 68-75. doi: 10.1111/tri.12874 https://archive-ouverte.unige.ch/unige:107779

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Deposited on : 2018-09-14

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