BACKGROUND: Preemptive kidney transplantation (prior to the institution of dialysis) avoids the morbidity and mortality of dialysis; however, detailed studies of high-risk patients are lacking. The aim of the current study was to compare recent outcomes of preemptive (P) versus nonpreemptive (NP) living donor kidney transplantation with an emphasis on high-risk recipients. METHODS: We retrospectively analyzed 438 sequential solitary living donor kidney transplants at our institution between January 2000 and December 2002. In all, 44% were preemptive. NP recipients were dialyzed for 21+/-36 months (range 1-312 months). RESULTS: Overall, three-year patient survival was similar in the NP and P groups. When stratified by diabetes and age >65 years, P and NP recipients again showed similar survival. Death-censored three-year graft survival was better in the P group (97% vs. 90%, P=0.01), but was not significant by multivariate analysis. Delayed graft function was more frequent in NP vs. P (10% vs. 4%; P=0.01), but other early complications were similar including: acute rejection, 16% vs. 11% (P=0.11); primary nonfunction, 3% vs. 2% (P=0.38); and wound complications, 19% vs. 17% (P=0.54). Glomerular filtration rate at three years was similar in the two groups (53+/-23 preemptive vs. 52+/-20 ml/min nonpreemptive; P=0.37). CONCLUSION: With prompt referral and workup, preemptive kidney transplantation can be performed successfully in a large percentage of renal allograft recipients. Preemptive transplantation avoids unnecessary dialysis and should be emphasized as initial therapy for many patients with end-stage renal disease.
BACKGROUND: Preemptive kidney transplantation (prior to the institution of dialysis) avoids the morbidity and mortality of dialysis; however, detailed studies of high-risk patients are lacking. The aim of the current study was to compare recent outcomes of preemptive (P) versus nonpreemptive (NP) living donor kidney transplantation with an emphasis on high-risk recipients. METHODS: We retrospectively analyzed 438 sequential solitary living donor kidney transplants at our institution between January 2000 and December 2002. In all, 44% were preemptive. NP recipients were dialyzed for 21+/-36 months (range 1-312 months). RESULTS: Overall, three-year patient survival was similar in the NP and P groups. When stratified by diabetes and age >65 years, P and NP recipients again showed similar survival. Death-censored three-year graft survival was better in the P group (97% vs. 90%, P=0.01), but was not significant by multivariate analysis. Delayed graft function was more frequent in NP vs. P (10% vs. 4%; P=0.01), but other early complications were similar including: acute rejection, 16% vs. 11% (P=0.11); primary nonfunction, 3% vs. 2% (P=0.38); and wound complications, 19% vs. 17% (P=0.54). Glomerular filtration rate at three years was similar in the two groups (53+/-23 preemptive vs. 52+/-20 ml/min nonpreemptive; P=0.37). CONCLUSION: With prompt referral and workup, preemptive kidney transplantation can be performed successfully in a large percentage of renal allograft recipients. Preemptive transplantation avoids unnecessary dialysis and should be emphasized as initial therapy for many patients with end-stage renal disease.
Authors: Michael Abecassis; Stephen T Bartlett; Allan J Collins; Connie L Davis; Francis L Delmonico; John J Friedewald; Rebecca Hays; Andrew Howard; Edward Jones; Alan B Leichtman; Robert M Merion; Robert A Metzger; Francoise Pradel; Eugene J Schweitzer; Ruben L Velez; Robert S Gaston Journal: Clin J Am Soc Nephrol Date: 2008-02-06 Impact factor: 8.237
Authors: Maximilian Brunotte; Sebastian Rademacher; Justine Weber; Elisabeth Sucher; Andri Lederer; Hans-Michael Hau; Jens-Uwe Stolzenburg; Daniel Seehofer; Robert Sucher Journal: Ann Transl Med Date: 2020-03
Authors: Massini A Merzkani; Andrew J Bentall; Byron H Smith; Xiomara Benavides Lopez; Matthew R D'Costa; Walter D Park; Walter K Kremers; Naim Issa; Andrew D Rule; Harini Chakkera; Kunam Reddy; Hasan Khamash; Hani M Wadei; Martin Mai; Mariam P Alexander; Hatem Amer; Aleksandra Kukla; Mireille El Ters; Carrie A Schinstock; Manish J Gandhi; Raymond Heilman; Mark D Stegall Journal: Transplant Direct Date: 2022-01-13