In Reply

Correspondence regarding the article Allocation Rules and Age-Dependent Waiting Times for Kidney Transplantation by Dr. med. Benedikt Kolbrink, Dr. med. Nassim Kakavand, Jakob C. Voran, Prof. Dr. rer. nat. Helena U. Zacharias, Dr. med. Axel Rahmel, Dr. Serge Vogelaar, Prof. Dr. rer. nat. Silke Schicktanz, Prof. Dr. med. Felix Braun, Prof. Dr. med. Roland Schmitt, Dr. med. Friedrich A. von Samson-Himmelstjerna, and PD Dr. med. Kevin Schulte in issue 17/2024

We are very pleased that a group of very deserving physicians with many years of experience in transplantation medicine also consider the distribution of donor kidneys described by us to be problematic and difficult to justify. We hope that this will encourage them to work for change for the better.

We can well understand their criticism regarding the quality of the data of the Transplant Registry. The longitudinal data quality is indeed not good enough to support differentiated analyses of the post-transplant long-term clinical course. Currently, we should use other data sources for this purpose.

Where we do not agree with our colleagues is the pessimism regarding the overall benefit of the Transplant Registry for transplantation medicine in Germany. Even with the currently available data, which are of good quality at least at the time of transplantation, it is possible to perform valid analyses. For example, the registry data allow to investigate relevant processes related to organ transplantation, such as the problematic age distribution of transplant kidneys (1), and to comparatively describe deficits in the waiting list process before kidney transplantation across the regions (2).

We are somewhat more optimistic about the future in this respect and believe that the Transplant Registry certainly represents an opportunity to shed light on processes central to German transplantation medicine. Of course, the theoretical potential of the registry is far greater; however, all legitimate criticism must not distract us from tackling the obvious problems courageously—true to the motto ”There is no good, unless you do good!“.

DOI: 10.3238/arztebl.m2024.0221

Corresponding author

Dr. med. Benedikt Kolbrink

Klinik für Nieren- und Hochdruckkrankheiten

Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany

Conflict of interest

BK received research funding from Sanofi.

References

1. Kolbrink B, Kakavand N, Voran JC, et al.: Allocation rules and age-dependent waiting times for kidney transplantation—an analysis of data from the German Transplantation Registry. Dtsch Arztebl Int 2024; 121: 559–65

2. von Samson-Himmelstjerna FA, Kolbrink B, Kakavand N, Zacharias HU, Schulte K: The German transplantation registry reveals deficiencies in the listing process for kidney transplantation. Kidney Int Rep 2023; 8: 2701–8