[Kidney transplantation without previous dialysis: limitations, but also possibilities].
Kidney transplantation guarantees a better quality of life than dialysis and is less costly. Transplantation without preceding dialysis is an attractive option. However, transplantation long before end-stage renal failure prolongs the period of exposure to immunosuppressive therapy, thereby increasing the risk of malignancy. Transplantation at one year before dialysis-dependency is expected would seem an acceptable compromise. Unfortunately, this option is purely theoretical because there is a long waiting-list due to the existing donor shortage. Patients are usually put on the waiting-list after dialysis has already been started. Extension of the list with pre-dialysis patients is currently only justifiable in exceptional cases. These limitations do not apply to patients who have received an offer of kidney donation from a living (related or unrelated) donor. In these patients transplantation can be done as soon as the creatinine clearance has reached a level of 10-12 ml per minute. More attention should be paid to this form of transplantation, because it can help to decrease the donor shortage.
Koene
R A
RA
Academisch Ziekenhuis, afd. Nierziekten, Nijmegen.
Hoitsma
A J
AJ
D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation; D011300:Preoperative Care; D006435:Renal Dialysis; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D014850:Waiting Lists