The effects of changing methods on patient and graft survival in cadaveric kidney allocation

Renal replacement is the ideal treatment for end stage kidney disease. Cadaveric kidney donation is very low compared to the number of patients waiting for renal transplantation in Turkey. Before year 2008 organ transplant centers in Turkey were free in choosing the recipient from their own waiting list for cadaveric kidney transplantation. Centers were choosing low risk patients who were younger, have no or minimal comorbidity and had no previous transplants in order to increase the success of transplantation. This created a significant disadvantage for older patients with higher dialysis vintage, comorbidities and previous transplants. However, in 2008, Turkish Health Ministry established a new cadaveric kidney allocation policy. According to this policy, potential recipients get points with regard to their age, duration of hemodialysis, level of HLA match with the donor, location of the donor. Patient with the highest point is offered to receive the kidney. The aim of this study was to compare the short and long term effects of this policy change on graft and patient survival. A total of 47 cadaveric renal transplant recipients that were transplanted before 2008 and 80 cadaveric renal transplant recipients that were transplanted after 2008 were included. 40 live kidney transplant recipient transplanted before 2008 and 40 live kidney transplant recipients transplanted after 2008 were also included as the control group. Patients received cadaveric transplants after 2008 were older, had longer cold ischemia time, had higher risk of delayed graft function and had higher risk of acute rejection in the first three months after transplantation. However long term graft functions, graft and patient survival was similar between patients received cadaveric transplants before and after 2008.