Outcome of preemptive renal transplantation versus waiting time on dialysis

Abstract

1. Twenty-five percent of living-donor kidney transplants were performed preemptively between 1994-2002. There was a modest increase in preemptive transplantation from 22% in 1994 to 27% in 2001. Among recipients of cadaveric grafts, 7% received preemptive transplants. 2. Preemptive transplants had superior outcomes in terms of both graft and patient survival. The difference in graft survival between preemptive and non-preemptive transplants was partially attributable to patient death. 3. Donor and recipient characteristics differed significantly among recipients of preemptive and non-preemptive transplants, regardless of the donor source. 4. Preemptive transplant recipients had a lower incidence of posttransplant dialysis, first day anuria, and rejection episodes before discharge than those transplanted after increasing time on dialysis. The risk-ratios for these posttransplant complications did not differ significantly between the preemptive transplant recipients and those transplanted within 6 months of beginning dialysis. 5. Graft survival rates decreased with increasing duration of pretransplant dialysis for both living and cadaver donor transplant recipients. However, when only recipients with good early graft function were considered, patients on dialysis for up to one year had graft survival rates comparable to those of preemptive transplant recipients. 6. For patients with a suitable living donor, transplantation as early as possible seems indicated.