Preemptive Kidney Transplant From Deceased Donors: An Advantage in Relation to Reduced Waiting List

Pérez‐Flores, Isabel; Sánchez‐Fructuoso, Ana; Calvo, N.; Marqués, María; Anaya, S; Ridao, N.; Rodriguez, A; Barrientos, Alberto

doi:10.1016/j.transproceed.2007.06.034

Cited by 15 publications

(10 citation statements)

References 5 publications

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“…[10][11][12] One of the main advantages promoted for preemptive transplantation is improved patient and allograft survival. [19][20][21][22][23][24][25] Potential harms of earlier transplantation include longer exposure of the recipient to immunosuppression and earlier exposure of the donor to the risks of having a single kidney. The patient survival benefit, however, has not been universally demonstrated.…”

Section: Introductionmentioning

confidence: 99%

Quantifying lead time bias when estimating patient survival in preemptive living kidney donor transplantation

Irish

Chadban

McDonald

et al. 2019

American Journal of Transplantation

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Preemptive kidney transplantation is the preferred initial renal replacement therapy, by avoiding dialysis and reportedly maximizing patient survival. Lead time bias may account for some or all of the observed survival advantage, but the impact of this has not been quantified. Using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we included adult recipients of living donor kidney transplants during 1998‐2017. Patients were transplanted preemptively (n = 1435) or after receiving up to 6 months of dialysis (n = 712). We created a matched cohort using propensity scores, and accounted for lead time (dialysis and estimated predialysis) using left‐truncated Cox models with the primary outcome of patient survival. The median eGFR at transplantation was 6.9 mL/min per 1.73 m2 in the non‐pre‐emptive, and 9.6 mL/min per 1.73 m2 in the preemptive group. In the matched cohort (n = 1398), preemptive transplantation was not associated with a survival advantage hazard ratio (HR) for preemptive vs non‐pre‐emptive 1.12 (95% confidence interval [CI] 0.79‐1.61). Accounting for lead time moved the point estimates toward a survival disadvantage for preemptive transplantation (eg, HR assuming 4 mL/min per 1.73 m2/year eGFR decline, 1.21 [0.85, 1.73]), but in all cases the 95% CIs crossed 1. The optimal timing of preemptive living donor kidney transplantation requires further study.

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Section: Introductionmentioning

confidence: 99%

Quantifying lead time bias when estimating patient survival in preemptive living kidney donor transplantation

Irish

Chadban

McDonald

et al. 2019

American Journal of Transplantation

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“…In our patients receiving kidneys from deceased donors, graft function remained very stable during observation time at a lower baseline eGFR. When comparing KALTPL from a deceased donor to patients on dialysis, superior outcome regarding comorbidities has been reported . Therefore, transplantation of a kidney from a deceased donor seems a valuable option if no living donor is available.…”

Section: Discussionmentioning

confidence: 99%

Evolution of lung and kidney allograft function in patients receiving kidney after lung transplantation

Weber

Bonani

Benden³

et al. 2017

Clinical Transplantation

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Calcineurin inhibitor (CNI) toxicity leads to end-stage renal disease in almost half of long-term survivors after lung transplantation, some of them receiving kidney transplants. Little is known about the outcomes of kidney and lung allograft function following kidney after lung transplantation (KALTPL) in the modern era. We retrospectively analyzed a group of 13 consecutive patients who received a KALTPL with respect to their renal and pulmonary function and immunological evolution over 2 years. We documented a stable evolution of forced expiratory volume in 1 second (FEV1) after KALTPL in most patients as well as an excellent kidney graft during the 2-year follow-up period. In our small cohort, living donations showed a significantly higher estimated glomerular filtration rate compared to deceased donation (75.7 compared to 41.6 mL/min). Patients who received a preemptive KALTPL were more likely to improve their lung function after KALTPL. Four patients developed de novo donor-specific antibodies (DSA) against the kidney graft. There were no DSA against shared antigens from the lung allograft. De novo DSA did not lead to graft loss in any patient. All 13 patients survived the first 24 months after KALTPL.

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“…Therefore, facilitating transplantation in already-dialyzed patients, and simultaneously allowing PET, we create a policy that is beneficial for the individual patient and provides a constant influx of new pre-emptively referred candidates to the transplant waiting list. The policy increases the ability to effectively manage the waiting list [21].…”

Section: Discussionmentioning

confidence: 99%

Preemptive Kidney Transplantation: Analysis of Kidney Grafts From the Same Donor

Dębska-Ślizień

Bzoma

Moszkowska

et al. 2014

Transplantation Proceedings

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Preemptive Kidney Transplant From Deceased Donors: An Advantage in Relation to Reduced Waiting List

Cited by 15 publications

References 5 publications

Quantifying lead time bias when estimating patient survival in preemptive living kidney donor transplantation

Quantifying lead time bias when estimating patient survival in preemptive living kidney donor transplantation

Evolution of lung and kidney allograft function in patients receiving kidney after lung transplantation

Preemptive Kidney Transplantation: Analysis of Kidney Grafts From the Same Donor

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