The Impact of Nationwide Allocation System on Kidney Transplantation: A Single-Center Experience

Objectives: Organ allocation is of decisive importance in the current situation of organ shortage. The aim of this study is to compare the long-term graft outcomes of deceased donor recipients before and after the new nationwide allocation system in Taiwan. Methods: From April 1, 2000 to March 31, 2010, 181 deceased kidney transplantations were reviewed retrospectively, and recipients were divided by the enforcement day (April 1, 2005) of nationwide allocation into group 1 (before) and group 2 (after). Baseline demographics were reviewed. Outcomes, including graft survival (GS) and patient survival, at 1-, 3-, 5-, and 10-years after transplantation were analyzed. Results: The baseline demography was similar between the 2 groups except that group 1 is younger. Group 2 has less HLA-B (P <.001) and HLA mismatches (P =.005). There were significantly more 0-mismatch recipients in group 2 (6 vs 27, P =.001), as well as extended criteria donor (ECD) recipients (0 vs 7). Group 2 has less optimal 1-year GS (95.6% vs 86.8%, Log-Rank P =.037), which becomes nonsignificant at 3-, 5-, and 10-years after transplantation. By excluding ECD recipients, the GS were similar at all time. There was no difference in patient survival between the 2 groups. Conclusion: The new nationwide allocation system provided us more 0-mismatch kidneys. The nationwide scheme remains beneficial to kidney recipients after the acute adverse effects of ECD and aging vanish.