Preemptive Kidney Transplantation

Abstract

Abstract. It remains unclear whether preemptive transplantation is beneficial, and if so, who benefits. A total of 38,836 first, kidney-only transplants between 1995 and 1998 were retrospectively studied. A surprising 39% of preemptive transplants were from cadaver donors, and the proportions of cadaver donor transplants that were preemptive changed little, from 7.3% in 1995 to 7.7% in 1998. Preemptive transplants using cadaver donors were more likely among recipients aged 0 to 17 yr versus 18 to 29 yr (odds ratio [OR]

Preemptive Renal Transplantation: Why Not?

“…Preemptive renal transplantation occurred in 25% of adult recipients of allografts from living donors in the United States in the latter part of the twentieth century (2,3). The lower rate of PRT of cadaveric renal allografts into adult recipients, approaching 10%, is likely attributable to the prolonged waiting times of transplant candidates on the cadaveric list, during which persons become dialysisdependent.…”

“…An analysis of 4095 PRT recipients of a renal allograft during 1994 through 2000 in the United States revealed that the estimated glomerular filtration rates (GFRs) averaged 9.9 mL/min [SD (5,3)] at the time of transplantation (6); levels that were significantly less than the suggested threshold of 14 mL/min for dialysis initiation proposed by the KDOQI working group (1). These observations were corroborated by a second study that also demonstrated individuals transplanted preemptively with a cadaveric renal allograft have severe renal insufficiency at the time of transplantation (median serum creatinine level of 8.6 mg/dL), indicating the need for a therapeutic intervention (7).…”

“…The observation that better educated individuals, Caucasians, and persons with higher incomes in the United States are more likely to be placed on the cadaveric waiting list before dialysis initiation and receive a PRT might suggest that the impact of PRT on survival represents a systematic bias (3,16). Despite these observations, accounting for the measured differences in socioeconomic status, the survival advantage associated with PRT in two large studies was not explained (2,3).…”

The State of U.S. Living Kidney Donors

“…L iving organ donors are the inspiration of transplantation, leading to earlier transplantation and better recipient survival (1)(2)(3)(4). This is particularly true for kidney transplantation, where 55,912 (49.5%) of the 112,948 kidney donors between 2000 and 2008 were living donors.…”

O papel global do transplante renal

“…16 Pre-emptive transplantation is associated with a 25% reduction in transplant failure and 16% reduction in mortality compared to recipients receiving a transplant after starting dialysis. 17 Transplantation of the kidney, when properly applied, is thus the treatment of choice for patients with ESRD because of lower costs and better outcomes.…”