Assessment of access and outcomes of kidney transplantation through the reforms of the Swiss organ allocation system
IntroductionThe Swiss allocation system for kidney transplantation has evolved over time to balance medical urgency, immunological compatibility, and waiting time. Since the introduction of the transplantation law in 2007, which imposed organ allocation on a national level, the algorithm has been op...
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Frontiers Media S.A.
2025-01-01
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| author | Massimiliano Bertacchi Sylvie Ferrari-Lacraz Jakob Nilsson Agim Thaqi Yvan Schmutz Caroline Wehmeier Thomas Schachtner Thomas Mueller Dela Golshayan Julien Vionnet Stefan Schaub Fadi Haidar Isabelle Binet Jutta Thierbach Urs Wirthmueller Daniel Sidler Franz Immer Jean Villard |
| author_facet | Massimiliano Bertacchi Sylvie Ferrari-Lacraz Jakob Nilsson Agim Thaqi Yvan Schmutz Caroline Wehmeier Thomas Schachtner Thomas Mueller Dela Golshayan Julien Vionnet Stefan Schaub Fadi Haidar Isabelle Binet Jutta Thierbach Urs Wirthmueller Daniel Sidler Franz Immer Jean Villard |
| author_sort | Massimiliano Bertacchi |
| collection | DOAJ |
| description | IntroductionThe Swiss allocation system for kidney transplantation has evolved over time to balance medical urgency, immunological compatibility, and waiting time. Since the introduction of the transplantation law in 2007, which imposed organ allocation on a national level, the algorithm has been optimized. Initially based on waiting time, HLA compatibility, and crossmatch performed by cell complement-dependent cytotoxicity techniques, the system moved in 2012 to a score including HLA compatibility, waiting time, anti-HLA antibodies detected by the Luminex® technology, and a virtual crossmatch. In 2015, the score was optimized to balance the impact of preemptive listing and HLA matching of hyperimmunized recipients.MethodsWe reviewed access to transplants and post-transplant outcomes along those changes, defining three periods (v0: 2007–2012, v1: 2012–2015, v2: 2015–2020).ResultsChanges in the Swiss allocation system improved the fairness of access to transplantation, particularly for hyperimmunized patients. However, the system still fails to grant fair access to some blood groups. Furthermore, our data showed that rule modifications did not impact early post-transplant complications, maintaining similar time to first rejection and 1-year graft survival across subgroups.DiscussionSuch an analysis is useful for validating changes made to the allocation system and identifying aspects that need to be implemented in future revisions. |
| format | Article |
| id | doaj-art-1390731101214634aa3f42a0ab84fb38 |
| institution | Kabale University |
| issn | 2296-2565 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj-art-1390731101214634aa3f42a0ab84fb382025-01-08T06:12:03ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-01-011210.3389/fpubh.2024.15007811500781Assessment of access and outcomes of kidney transplantation through the reforms of the Swiss organ allocation systemMassimiliano Bertacchi0Sylvie Ferrari-Lacraz1Jakob Nilsson2Agim Thaqi3Yvan Schmutz4Caroline Wehmeier5Thomas Schachtner6Thomas Mueller7Dela Golshayan8Julien Vionnet9Stefan Schaub10Fadi Haidar11Isabelle Binet12Jutta Thierbach13Urs Wirthmueller14Daniel Sidler15Franz Immer16Jean Villard17Nephrology and Hypertension Division, Geneva University Hospitals, Geneva, SwitzerlandTransplant Immunology Unit, Geneva University Hospitals, Geneva, SwitzerlandDepartment of Immunology, University Hospital Zurich, Zurich, SwitzerlandFederal Office of Public Health, Bern, SwitzerlandAnalytica SA, Lausanne, SwitzerlandNephrology and Transplant Immunology Division, University Hospital Basel, Basel, SwitzerlandNephrology Division, University Hospital Zurich, Zurich, SwitzerlandNephrology Division, University Hospital Zurich, Zurich, SwitzerlandTransplantation Center, Centre Hospitaliser Universitaire Vaudois, Lausanne, SwitzerlandDivision of Immunology and Allergy, Centre Hospitaliser Universitaire Vaudois, Lausanne, SwitzerlandNephrology and Transplant Immunology Division, University Hospital Basel, Basel, SwitzerlandNephrology and Hypertension Division, Geneva University Hospitals, Geneva, Switzerland0Clinic for Nephrology and Transplantation Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland1Blood Transfusion Service Eastern Switzerland, Swiss Red Cross, St. Gallen, Switzerland2Department of Laboratory Medicine, Inselspital, Bern University Hospital, Bern, Switzerland3Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, Bern, Switzerland4Swisstransplant, The Swiss National Foundation for Organ Donation and Transplantation, Bern, SwitzerlandTransplant Immunology Unit, Geneva University Hospitals, Geneva, SwitzerlandIntroductionThe Swiss allocation system for kidney transplantation has evolved over time to balance medical urgency, immunological compatibility, and waiting time. Since the introduction of the transplantation law in 2007, which imposed organ allocation on a national level, the algorithm has been optimized. Initially based on waiting time, HLA compatibility, and crossmatch performed by cell complement-dependent cytotoxicity techniques, the system moved in 2012 to a score including HLA compatibility, waiting time, anti-HLA antibodies detected by the Luminex® technology, and a virtual crossmatch. In 2015, the score was optimized to balance the impact of preemptive listing and HLA matching of hyperimmunized recipients.MethodsWe reviewed access to transplants and post-transplant outcomes along those changes, defining three periods (v0: 2007–2012, v1: 2012–2015, v2: 2015–2020).ResultsChanges in the Swiss allocation system improved the fairness of access to transplantation, particularly for hyperimmunized patients. However, the system still fails to grant fair access to some blood groups. Furthermore, our data showed that rule modifications did not impact early post-transplant complications, maintaining similar time to first rejection and 1-year graft survival across subgroups.DiscussionSuch an analysis is useful for validating changes made to the allocation system and identifying aspects that need to be implemented in future revisions.https://www.frontiersin.org/articles/10.3389/fpubh.2024.1500781/fullkidney transplantationallocation systemtransplant immunologyallocation fairnesshyperimmunized patientswaiting time |
| spellingShingle | Massimiliano Bertacchi Sylvie Ferrari-Lacraz Jakob Nilsson Agim Thaqi Yvan Schmutz Caroline Wehmeier Thomas Schachtner Thomas Mueller Dela Golshayan Julien Vionnet Stefan Schaub Fadi Haidar Isabelle Binet Jutta Thierbach Urs Wirthmueller Daniel Sidler Franz Immer Jean Villard Assessment of access and outcomes of kidney transplantation through the reforms of the Swiss organ allocation system Frontiers in Public Health kidney transplantation allocation system transplant immunology allocation fairness hyperimmunized patients waiting time |
| title | Assessment of access and outcomes of kidney transplantation through the reforms of the Swiss organ allocation system |
| title_full | Assessment of access and outcomes of kidney transplantation through the reforms of the Swiss organ allocation system |
| title_fullStr | Assessment of access and outcomes of kidney transplantation through the reforms of the Swiss organ allocation system |
| title_full_unstemmed | Assessment of access and outcomes of kidney transplantation through the reforms of the Swiss organ allocation system |
| title_short | Assessment of access and outcomes of kidney transplantation through the reforms of the Swiss organ allocation system |
| title_sort | assessment of access and outcomes of kidney transplantation through the reforms of the swiss organ allocation system |
| topic | kidney transplantation allocation system transplant immunology allocation fairness hyperimmunized patients waiting time |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2024.1500781/full |
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