Trends in kidney transplantation rate across Europe: study from the ERA Registry (original) (raw)
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Factors influencing kidney transplantation rates: a study from the ERA Registry
Nephrology Dialysis Transplantation, 2023
Background. Large international differences exist in kidney transplantation (KT) rates. We aimed to investigate which factors may explain the total, deceased donor, and living donor KT rates over the last decade. Methods. KT experts from 39 European countries completed the Kidney Transplantation Rate Survey on measures and barriers and their potential effect on the KT rate in their country. In the analyses, countries were divided into low, middle, and high KT rate countries based on the KT rate at the start of study period in 2010. Results. Experts from low KT rate countries reported more frequently to have taken measures regarding staff, equipment and facilities to increase total KT rate compared with middle and high KT rate countries. For donor type specific KT, the largest international differences in measures taken were reported for deceased donor KT, with middle and high KT rate countries taking more measures, such as the use of expanded criteria donor kidneys, the presence of transplantation coordinators, and (inter)national exchange of donor kidneys. Once a measure was taken, experts' opinion on its success was similar across the low, middle and high KT rate countries. Experts from low KT rate countries more often reported potential barriers, such as patients' lack of knowledge and distrust in the health care system.
Nephrology Dialysis Transplantation, 2021
Background We investigated 10-year trends in deceased donor kidney quality expressed as the kidney donor risk index (KDRI) and subsequent effects on survival outcomes in a European transplant population. Methods Time trends in the crude and standardized KDRI between 2005 and 2015 by recipient age, sex, diabetic status and country were examined in 24 177 adult kidney transplant recipients in seven European countries. We determined 5-year patient and graft survival probabilities and the risk of death and graft loss by transplant cohort (Cohort 1: 2005–06, Cohort 2: 2007–08, Cohort 3: 2009–10) and KDRI quintile. Results The median crude KDRI increased by 1.3% annually, from 1.31 [interquartile range (IQR) 1.08–1.63] in 2005 to 1.47 (IQR 1.16–1.90) in 2015. This increase, i.e. lower kidney quality, was driven predominantly by increases in donor age, hypertension and donation after circulatory death. With time, the gap between the median standardized KDRI in the youngest (18–44 years) an...
A retrospective and prospective study of the number of kidney transplants in 31 countries
Transplant International, 1989
The aim of the present study was to try to predict the number of cadaveric kidney transplantations (CKT) that will be performed in the year 1993. The raw data regarding the number of renal transplants that have been performed annually since 1975 in 31 countries, which were divided into six groups, were collected from published reports and confirmed by a questionnaire sent to all centers. The annual number of grafts was estimated using an exponential model, highly correlated with retrospective data (3 > 0.99). Predictions for 1993 were extrapolated. The growth of transplantation activity is limited by a shortage of available donor organs. The maximum number of grafts was arbitrarily set at 40 per million population, which is the maximum rate currently observed. The total number of CKT carried out between 1975 and 1986 was 114000; this will probably exceed 280000 in 1993. The yearly activity in 1987 exceeded 16500 and is expected to reach approximatively 26000 grafts in 1993.
Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2015
In this position article, DESCARTES (Developing Education Science and Care for Renal Transplantation in European States) board members describe the current strategies aimed at expanding living and deceased donor kidney pools. The article focuses on the recent progress in desensitization and kidney paired exchange programmes and on the expanded criteria for the use of donor kidneys and organs from donors after circulatory death. It also highlights differences in policies and practices across different regions with special regard to European Union countries. Living donor kidney paired exchange, the deceased donor Acceptable Mismatch Programme and kidneys from donors after circulatory death are probably the most promising innovations for expanding kidney transplantation in Europe over the coming decade. To maximize success, an effort is needed to standardize transplant strategies, policies and legislation across European countries.
Temporal trends in living kidney donation in France between 2007 and 2017
Nephrology Dialysis Transplantation, 2019
Background Long-term studies have demonstrated a slight increased risk for end-stage renal disease (ESRD) for living kidney donors (LKD). In France, living kidney donation doubled within the past 10 years. We investigated the change in characteristics of LKD between 2007 and 2017 and the adequacy of follow-up. Methods Data were obtained from the national registry for LKD. We compared characteristics of LKD between two study periods: 2007–11 and 2012–17, and stratified donors by age and relation to recipient. We aggregated four characteristics associated with higher ESRD risk [young age, first-degree relation to recipient, obesity, low glomerular filtration rate (GFR) for age] in a single risk indicator ranging from 0 to 4. Results We included 3483 donors. The proportion of unrelated donors >56 years of age increased significantly. The proportion of related donors <56 years of age decreased significantly. The body mass index and proportion of obese donors did not change signifi...
State of living kidney donation in Europe
Nephrology Dialysis Transplantation, 2012
For more than two decades, living donation has been an important part of kidney transplantation. This article discusses commonalities and differences of living donation across Europe, focussing on donor risks and ways to support the donor and enhance living donation practices.
2222 kidney transplantations at the University Hospital Basel: a story of success and new challenges
Swiss medical weekly, 2016
The aim was to investigate changes in kidney allograft donor/recipient characteristics and outcomes at our centre. We retrospectively reviewed all 2222 kidney transplantations performed between 1967 and 2015. The population was divided into four eras on the basis of time intervals corresponding to major changes in immunosuppression and pretransplant risk stratification: (i.) 1967-1980 (n = 231), (ii.) 1981-1997 (n = 883), (iii.) 1998-2004 (n = 437), (iv.) 2005-2015 (n = 671). In deceased donor transplants, we observed a continuous increase of the median recipient (45, 51, 56 and 58 years; p <0.0001) and donor (26, 36, 49 and 54 years; p <0.0001) age. Notably, the frequency of expanded criteria donors increased dramatically (1%, 10%, 28%, 40%, p <0.0001). Graft survival at 1 year (63%, 82%, 89%, 95%), 5 years (46%, 66%, 72%, 78%) and 10 years (27%, 46%, 48%, 61%) significantly improved (p <0.0001). Patient survival also significantly improved and remained stable at a high...
Progress in Transplantation, 2009
D espite the increase in the number of organ donors in recent years, a large gap remains between the number of patients on the waiting list and the number of kidney transplants performed. 1 This disparity stimulates a responsibility in the transplant community to maximize the use of organs procured from deceased donors. Decreases in donor organ damage, improvements in posttransplant organ function, and the reassuring experiences of other centers with the use of expandedcriteria donors have allowed a broadening of the strict criteria for donor selection. Donors with adverse medical characteristics once thought to be a contraindications for donation are therefore being used more and more often. 2 This worsening of the donor profile further increases the pressure on organ exchange organizations to minimize their organ discard rates. What are the donor factors that lead to discard of a donor kidney? If this information is known beforehand, a potential difficult-to-allocate donor can be anticipated and a rescue allocation process can be started earlier in the process. Most importantly, early identification of factors that jeopardize kidney transplantability should not lead to cancellation of the donation and allocation process, but on the contrary should lead to the recognition that those donated organs will most probably be allocated via the rescue allocation scheme. Kidney donation and transplantation in Eurotransplant 2006-2007: minimizing discard rates by using a rescue allocation policy Context-All organ exchange organizations are challenged to maximize the utilization rate of all donors. Objective-To investigate the benefit of a rescue allocation policy and to study the impact of donor factors on the risk of kidney discard. Design and Setting-All 4057 donors with kidneys offered for allocation to Eurotransplant between 2006 and 2007 were included. Allocation was patientoriented, based on a point-score system including recipient and donor factors. If an organ offer was rejected 5 times for medical reasons, allocation was switched to rescue allocation (ie, the organ was then offered in a center-oriented way). A logistic regression model was built to test whether donor factors were predictors of rescue allocation or kidney discard. Results-Rescue allocation was used for 665 donors (16.4%); within this group, transplant rate was 54.3%, resulting in a donor discard rate of 304 donors (7.5% of total study group). The multivariate model showed that rescue allocation was used significantly more for kidneys from child donors and donors with a high creatinine level. Moreover, testing positive for hepatitis B surface antigen or antibody to hepatitis C virus was associated with an increased probability of rescue allocation. Kidney discard was significantly associated with donation after cardiac death, donor age, serum creatinine level, history of diabetes, and history of hepatitis. Conclusions-Rescue allocation is effective in lowering donor discard rates. Even with rescue allocation, several donor factors were significantly associated with a higher discard rate. Use of liberal donor criteria and a rescue allocation policy can reduce kidney discards and thus shorten the waiting list for kidney transplantation.