Preemptive renal transplantation: why not?
Dialysis has been the long-established initial choice of treatment for persons with end-stage renal disease. Transplantation before dialysis, or preemptive renal transplantation (PRT), has been controversial because of the paucity of clinical evidence that has clarified the benefits vs. risks of this approach. However, several recent observational analyses indicate that PRT is the optimal strategy to benefit patients requiring renal replacement therapy. This current review will discuss the advantages that are associated with PRT, and will summarize studies that have investigated the impact of the timing of transplantation on outcomes. We will also discuss the utility of PRT from various perspectives, and describe the challenges ahead in expanding the opportunity of PRT for more patients.
Mange
Kevin C
KC
Division of Renal-Electrolyte and Hypertension, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. kmange@cceb.med.upenn.edu
Weir
Matthew R
MR
D000293:Adolescent; D000328:Adult; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000033:anatomy & histology; D007674:Kidney Diseases / Q000401:mortality; D016030:Kidney Transplantation / Q000379:methods*; D008875:Middle Aged; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome