Preemptive living-donor kidney transplantation: clinical course and outcome.
BACKGROUND
Dialysis is not only associated with morbidity, it is also expensive. In developing countries, preemptive renal transplantation (Tx) may be a cost-effective option, offering an additional benefit to conventional renal Tx.


METHODS
Between March 1976 and March 2001, 1,279 first living-donor Txs were performed in our center. The 82 patients (6.4%) who underwent Tx without prior dialysis were compared with 1,197 patients who had been dialyzed before Tx.


RESULTS
The dialysis-dependent group received more blood transfusions (65% vs. 30%) before Tx. Actuarial graft and patient survival at 5 years was comparable in both groups (P =0.2 and P =0.8, respectively). The incidence of acute and chronic rejection was not different between the two groups. Mortality rate was also similar in the two groups. The main cause of death with a functioning graft was cardiovascular in the preemptive Tx group and chronic liver disease and infection in the control group.


CONCLUSIONS
In the context of a developing country, preemptive Tx offers comparable patient and graft survival to conventional renal Tx and eliminates the complications, inconvenience, and cost of dialysis.
el-Agroudy
Amgad E
AE
Urology and Nephrology Center, University of Mansoura, Mansoura, Egypt. amgadelbaz@ahram0505.net
Donia
Ahmed F
AF
Bakr
Mohamed A
MA
Foda
Mohamed A
MA
Ghoneim
Mohamed A
MA
D000328:Adult; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000191:economics* / Q000401:mortality*; D019520:Living Donors; D008297:Male; D006435:Renal Dialysis / Q000191:economics; D016019:Survival Analysis; D016896:Treatment Outcome