Das Eurotransplant Senior Programm – eine Erfolgsgeschichte?

Zusammenfassung

Seit 1999 werden im Eurotransplant Senior Programm (ESP) Nieren > 65-jähriger Spender regional > 65-jährigen Empfängern zugeteilt. Die Wartezeiten bis zur Transplantation sind dabei im ESP deutlich kürzer als im Standardallokationsprogramm ETKAS. Studien der letzten Jahre zeigen einen Reformbedarf bei den Allokationsregeln. Regionale Unterschiede bei der Wartezeit und die starre Altersgrenze zwischen ETKAS und ESP haben zu Fragen der Chancengleichheit geführt. Gewebeverträglichkeit und Immunisierung haben Einfluss auf das Transplantatüberleben und müssten folglich auch im ESP berücksichtigt werden. Immer älteren Patienten werden immer ältere Organe angeboten. Neue Untersuchungen zum Überleben nach Transplantation gegenüber einem Verbleib an der Dialyse hinterfragen kritisch die Sinnhaftigkeit von Nierentransplantationen in diesem Alterssegment. Wegen der kurzen Wartezeiten ist das ESP für ältere Patienten seit 25 Jahren eine Erfolgsgeschichte. Die Allokationsregeln müssen jedoch an den Stand der Wissenschaft angepasst werden.

Publikationsverlauf

Artikel online veröffentlicht:
03. Oktober 2025

• Literatur

• 1 Assfalg V, Miller G, Stocker F. et al. Rescue Allocation Modes in Eurotransplant Kidney Transplantation: Recipient Oriented Extended Allocation Versus Competitive Rescue Allocation-A Retrospective Multicenter Outcome Analysis. Transplantation 2024; 108: 1200-1211
• 2 Kayler LK, Magliocca J, Zendejas I. et al. Impact of cold ischemia time on graft survival among ECD transplant recipients: a paired kidney analysis. Am J Transplant 2011; 11: 2647-2656
• 3 Debout A, Foucher Y, Trebern-Launay K. et al. Each additional hour of cold ischemia time significantly increases the risk of graft failure and mortality following renal transplantation. Kidney Int 2015; 87: 343-349
• 4 Peters-Sengers H, Houtzager JHE, Idu MM. et al. Impact of Cold Ischemia Time on Outcomes of Deceased Donor Kidney Transplantation: An Analysis of a National Registry. Transplant Direct 2019; 5: e448
• 5 Echterdiek F, Latus J, Dohler B. et al. Influence of Cold Ischemia Time on the Outcome of Kidney Transplants from Donors Aged 70 Years and Above-A Collaborative Transplant Study Report. Transplantation 2021; 105: 2461-2469
• 6 Frei U, Noeldeke J, Machold-Fabrizii V. et al. Prospective age-matching in elderly kidney transplant recipients–a 5-year analysis of the Eurotransplant Senior Program. Am J Transplant 2008; 8: 50-57
• 7 Smits JM, Persijn GG, van Houwelingen HC. et al. Evaluation of the Eurotransplant Senior Program. The results of the first year. Am J Transplant 2002; 2: 664-670
• 8 Aubert O, Kamar N, Vernerey D. et al. Long term outcomes of transplantation using kidneys from expanded criteria donors: prospective, population based cohort study. BMJ 2015; 351 h3557
• 9 Betjes MGH, Kal-van Gestel JA, Roelen D. et al. Increasing donor kidney age significantly aggravates the negative effect of pretransplant donor-specific anti-HLA antibodies on kidney graft survival. Front Immunol 2025; 16 1574324
• 10 de Fijter J, Dreyer G, Mallat M. et al. A paired-kidney allocation study found superior survival with HLA-DR compatible kidney transplants in the Eurotransplant Senior Program. Kidney Int 2023; 104: 552-561
• 11 Lemoine M, Titeca Beauport D, Lobbedez T. et al. Risk Factors for Early Graft Failure and Death After Kidney Transplantation in Recipients Older Than 70 Years. Kidney Int Rep 2019; 4: 656-666
• 12 Eklou ND, Janigen BM, Pisarski P. et al. Evaluation of Deceased Donor Kidney Transplantation in the Eurotransplant Senior Program in Comparison to Standard Allocation. Ann Transplant 2022; 27 e936514
• 13 Dreyer GJ, de Fijter JW. Transplanting the Elderly: Mandatory Age- and Minimal Histocompatibility Matching. Front Immunol 2020; 11: 359
• 14 Bundesärztekammer. Richtlinie gemäß § 16 Abs. 1 S. 1 Nrn. 2 u. 5 TPG für die Wartelistenführung und Organvermittlung zur Nierentransplantation. DtschÄrztebl 2023; 120: A 116.
• 15 Zecher D, Tieken I, Wadewitz J. et al. Regional Differences in Waiting Times for Kidney Transplantation in Germany. Dtsch Arztebl Int 2023; 120: 393-399
• 16 King KL, Husain SA, Schold JD. et al. Major Variation across Local Transplant Centers in Probability of Kidney Transplant for Wait-Listed Patients. J Am Soc Nephrol 2020; 31: 2900-2911
• 17 Kolbrink B, Kakavand N, Voran JC. et al. Allocation Rules and Age-Dependent Waiting Times for Kidney Transplantation. Dtsch Arztebl Int 2024; 121: 559-565
• 18 Audry B, Savoye E, Pastural M. et al. The new French kidney allocation system for donations after brain death: Rationale, implementation, and evaluation. Am J Transplant 2022; 22: 2855-2868
• 19 NHS Blood and Transplant. Policies and guidance ODT NHS. POL186/21. Im Internet: https://www.odt.nhs.uk/transplantation/tools-policies-and-guidance/policies-and-guidance/ Stand: 03.07.2025
• 20 Strohmaier S, Wallisch C, Kammer M. et al. Survival Benefit of First Single-Organ Deceased Donor Kidney Transplantation Compared With Long-term Dialysis Across Ages in Transplant-Eligible Patients With Kidney Failure. JAMA Netw Open 2022; 5 e2234971
• 21 Shi B, Ying T, Chadban SJ. Survival after kidney transplantation compared with ongoing dialysis for people over 70 years of age: A matched-pair analysis. Am J Transplant 2023; 23: 1551-1560
• 22 Perez-Saez MJ, Arcos E, Comas J. et al. Survival Benefit From Kidney Transplantation Using Kidneys From Deceased Donors Aged > / = 75 Years: A Time-Dependent Analysis. Am J Transplant 2016; 16: 2724-2733
• 23 Legeai C, Andrianasolo RM, Moranne O. et al. Benefits of kidney transplantation for a national cohort of patients aged 70 years and older starting renal replacement therapy. Am J Transplant 2018; 18: 2695-2707
• 24 Hellemans R, Jager KJ, Abramowicz D. Transplantation in older individuals: is it really better than dialysis?. Curr Opin Organ Transplant 2020; 25: 86-91
• 25 Stel VS. Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: systematic review and meta-analysis. BMJ 2022 376. e068769 https://doi.org/10.1136/bmj-2021–068769
• 26 Naik MG, Greese V, Eckart K-U. et al. Survival Comparison of Waitlisted and Renal Transplanted Patients in the European Senior Programme [abstract]. Am J Transplant 2022 22. 3
• 27 Peters-Sengers H, Berger SP, Heemskerk MB. et al. Stretching the Limits of Renal Transplantation in Elderly Recipients of Grafts from Elderly Deceased Donors. J Am Soc Nephrol 2017; 28: 621-631
• 28 Hellemans R, Kramer A, De Meester J. et al. Does kidney transplantation with a standard or expanded criteria donor improve patient survival? Results from a Belgian cohort. Nephrol Dial Transplant 2021; 36: 918-926