Antonio Franco1, Patricio Más-Serrano2, Yussel González3, Noelia Balibrea3, David Rodríguez4, María Isabel López3, Francisco Javier Pérez Contreras3. 1. Servicio de Nefrología, Hospital General Universitario de Alicante, España. Electronic address: franco_ant@gva.es. 2. Servicio de Farmacia Hospitalaria, Hospital General Universitario de Alicante, España. 3. Servicio de Nefrología, Hospital General Universitario de Alicante, España. 4. Servicio de Nefrología, Hospital General Universitario de Alicante, España; Servicio de Farmacia Hospitalaria, Hospital General Universitario de Alicante, España.
Abstract
INTRODUCTION: Currently, kidney transplantation is the treatment of choice for patients with kidney disease who require replacement therapy. Dialysis is a necessary step, but not mandatory prior to transplantation. There is the possibility of pre-emptive transplantation or transplantation in pre-dialysis, that is, without previous dialysis. The aim of the present study is to evaluate the result of our experience with a pre-emptive kidney transplant from a deceased donor. MATERIALS AND METHODS: Retrospective, observational, matched cohort study. We compared 66 pre-emptive with 66 non pre-emptive recipients, who received a first renal graft performed at our centre, matched by age and gender of donors and recipients, time of transplant, immunological risk, immunosuppression and cold ischaemia time. Early graft loss, incidence of acute rejection, delayed graft function, renal function at 12 and 36 months and graft and recipient survival were assessed in this period. RESULTS: The percentage of recipients who presented early graft loss, delayed graft function and acute rejection was similar in both groups. No differences were observed in their renal function at 12 and 36 months after transplantation, as well as the actuarial survival of patients (P=0.801) and grafts (P=0.693) in the studied period. The total calculated cost of the period on dialysis for the control group was 8,033,893.16 euros. CONCLUSIONS: Pre-emptive transplantation can yield comparable outcomes to those for post-dialysis kidney transplantation, and results in better quality of life for patients with end-stage kidney disease, as well as a reduced cost.
INTRODUCTION: Currently, kidney transplantation is the treatment of choice for patients with kidney disease who require replacement therapy. Dialysis is a necessary step, but not mandatory prior to transplantation. There is the possibility of pre-emptive transplantation or transplantation in pre-dialysis, that is, without previous dialysis. The aim of the present study is to evaluate the result of our experience with a pre-emptive kidney transplant from a deceased donor. MATERIALS AND METHODS: Retrospective, observational, matched cohort study. We compared 66 pre-emptive with 66 non pre-emptive recipients, who received a first renal graft performed at our centre, matched by age and gender of donors and recipients, time of transplant, immunological risk, immunosuppression and cold ischaemia time. Early graft loss, incidence of acute rejection, delayed graft function, renal function at 12 and 36 months and graft and recipient survival were assessed in this period. RESULTS: The percentage of recipients who presented early graft loss, delayed graft function and acute rejection was similar in both groups. No differences were observed in their renal function at 12 and 36 months after transplantation, as well as the actuarial survival of patients (P=0.801) and grafts (P=0.693) in the studied period. The total calculated cost of the period on dialysis for the control group was 8,033,893.16 euros. CONCLUSIONS: Pre-emptive transplantation can yield comparable outcomes to those for post-dialysis kidney transplantation, and results in better quality of life for patients with end-stage kidney disease, as well as a reduced cost.
Authors: Alpha A Fowler; Jonathon D Truwit; R Duncan Hite; Peter E Morris; Christine DeWilde; Anna Priday; Bernard Fisher; Leroy R Thacker; Ramesh Natarajan; Donald F Brophy; Robin Sculthorpe; Rahul Nanchal; Aamer Syed; Jamie Sturgill; Greg S Martin; Jonathan Sevransky; Markos Kashiouris; Stella Hamman; Katherine F Egan; Andrei Hastings; Wendy Spencer; Shawnda Tench; Omar Mehkri; James Bindas; Abhijit Duggal; Jeanette Graf; Stephanie Zellner; Lynda Yanny; Catherine McPolin; Tonya Hollrith; David Kramer; Charles Ojielo; Tessa Damm; Evan Cassity; Aleksandra Wieliczko; Matthew Halquist Journal: JAMA Date: 2019-10-01 Impact factor: 56.272