title: Preemptive living-donor kidney transplantation: clinical course and outcome.
abstract: 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.
authors.affiliation: Urology and Nephrology Center, University of Mansoura, Mansoura, Egypt. amgadelbaz@ahram0505.net
authors.forename: Amgad E
authors.initials: AE
authors.lastname: el-Agroudy
authors.forename: Ahmed F
authors.initials: AF
authors.lastname: Donia
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Bakr
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Foda
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Ghoneim
mesh_terms: 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