Working with Eurotransplant to Optimise Organ Allocation
Ina Jochmans, MD, PhD University of Leuven, Belgium no relevant financial disclosures Phoenix Brussels & Antwerp in Belgium
http://earthobservatory.nasa.gov/IOTD 1958 anti-Mac J. Dousset
1965 HLA identification
1967 HLA-match Kidney J. van Rood 2014 Austria Belgium Croatia Germany Hungary Luxembourg 134 mi 1601 ~ 15,000 Netherlands Slovenia Transplant Centres:
40 5 23 > 7,000 organs/y
71 38 39 24% Eurotransplant factsheet 01/2015 EU directive
National Competent Authorities Transplant Transplant Donation Donation Allocation Allocation
OPO Eurotransplant Transplant centres Number deceased donors pmp <10
>25
Eurotransplant annual report 2014 DCD in only 3 countries
active programmes
Austria, Belgium, Netherlands
allowed, not active
Luxembourg, Slovenia
not allowed
Croatia, Germany, Hungary utilization urgency match outcome Median deceased donor age
54 y Donor age transplanted livers 100% 90% 25% 80% 70% 60% 20% 50% 40% 65+ 30% 56-64
20% 16-55 10% 0-15 0% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Organ utilization of reported deceased donors
80% Liver utilization 90%
85% Donor age
80% 0-15 16-55 75% 56-64 65+ 70%
65% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Liver utilization 90%
85% Donor age 80%
65+ 75%
70%
65% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Liver recipient age
100% 90% 80% 70% 60% 65+ 50% 56-64 40% 16-55 30% 0-15 20% 10% 0% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 DCD Liver utilization 250
200
150 Effective DCD 100 DCD livers transpl
50
0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 HU ACO T > ET •International •International •Regional / National •~ 10% •< 1% •Offering Scheme Recipient offer Acute liver (graft) failure Regular Mixed model - DBD recipient offer Extended - DCD centre offer
Rescue Centre offer Offering scheme of transplanted livers
100% 90% Extended or Rescue 80% 70% 60% Regular 50% Deviated offering 40% Regular offering 30% 20% 10% 0% 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Calc MELD Match = 9,57 ln Cr + 3,78 ln Bili + 11,2 ln INR + 6,43 MELD Exc MELD increase points / 3 mo Donor Match Waiting profile • “Standard” criteria List time country specific • “Non-Standard” • audit group • BE, GER, NL
Region
Eurotransplant manual 2015 Median (IQR) Calc MELD
18 (12-25) Recipient driven offering according to match list 15 (12-21) 19 (12-32) 13 (11-18) Mixed model - DBD recipient driven 16 (10-27) - DCD centre pick 17 (14-22) 16 (12-22 ) Centre driven offering with a match list match MELD transplanted patients
100% 90% 80% 70% 60% 50% Calc MELD 40% Exc MELD 30% 20% 10% 0% 2007 2008 2009 2010 2011 2012 2013 2014 2015 12
10 median CIT
8
6
4
Cold ischemia time (h) time ischemia Cold 2
0 2007 2008 2009 2010 2011 2012 2013 2014 2015 Median waiting time (mo) 100% 90% 80% 70% 60+ 60% 24-59 50% 12-23 40% 6-11 30% 0-5 20% 10% 0% 2014 Waitlist removals Recipient survival post liver transplant
Donor age (y)
0-15 (397) 16-55 (6,786) 56-64 (2,125) ≥65 (2,744)
2007 - 2014 Recipient survival post liver transplant
DCD (535) DBD (10,621)
Overall retransplant 13% 2007 - 2014 Liver offering in Eurotransplant is …
• Unique
• Effective
• Complex scope for unification
• Need for international monitoring outcome References
Eurotransplant data are available at www.statistics.eurotransplant.org
Eurotransplant annual reports available at www.eurotransplant.org