Änderungen der Allokation in der pädiatrischen Nierentransplantation bei Eurotransplant

Children and adolescents with end-stage renal disease are favoured in most organ allocation systems worldwide, because a prolonged waiting time on dialysis leads to irreversible disturbances of growth and of somatic and mental development, also because school education and professional training are hampered. In addition, the mortality of pediatric patients on chronic dialysis therapy is 4- to 5-fold higher than that after successful renal transplantation. The current regulations for the allocation of a kidney transplant for children and adolescents within Eurotransplant are problematic because of a relatively long waiting time (1.1. to 2.1 years, depending on the blood group), a fixed age limit of 16 years for the definition of a "pediatric patient"and no consideration of a certain age-matching between donor and recipient. In an intense discussion during the last three years in the Eurotransplant Kidney Advisory Committee (ETKAC) and in the Commission for Organ Transplantation of the German Board of Physicians important improvements of the allocation rules for pediatric patients could be achieved.These revisions of the allocation rules, which have become effective on December 8, 2010, are a significant improvement for pediatric patients, because (i) also adolescent patients above 16 years of age with still existing growth potential will be granted the pediatric bonus, (ii) the waiting time for all pediatric patients will be shortened by additional pediatric bonus points, (iii) kidney transplants from donors below the age of 16 years will be preferably allocated to pediatric recipients. Furthermore, one should continue to aim for a good HLA match, not only to achieve optimal graft survival, but also to avoid anti-HLA sensitization for a 2nd or 3rd transplant, which is likely to be required in young patients during their lifetime, and to reduce the complication of a posttransplant lymphoproliferative disease.