title: Preemptive living donor kidney transplantation: do the benefits extend to all recipients?
abstract: BACKGROUND
  Preemptive kidney transplantation (prior to the institution of dialysis) avoids the morbidity and mortality of dialysis; however, detailed studies of high-risk patients are lacking. The aim of the current study was to compare recent outcomes of preemptive (P) versus nonpreemptive (NP) living donor kidney transplantation with an emphasis on high-risk recipients.
  
  
  METHODS
  We retrospectively analyzed 438 sequential solitary living donor kidney transplants at our institution between January 2000 and December 2002. In all, 44% were preemptive. NP recipients were dialyzed for 21+/-36 months (range 1-312 months).
  
  
  RESULTS
  Overall, three-year patient survival was similar in the NP and P groups. When stratified by diabetes and age >65 years, P and NP recipients again showed similar survival. Death-censored three-year graft survival was better in the P group (97% vs. 90%, P=0.01), but was not significant by multivariate analysis. Delayed graft function was more frequent in NP vs. P (10% vs. 4%; P=0.01), but other early complications were similar including: acute rejection, 16% vs. 11% (P=0.11); primary nonfunction, 3% vs. 2% (P=0.38); and wound complications, 19% vs. 17% (P=0.54). Glomerular filtration rate at three years was similar in the two groups (53+/-23 preemptive vs. 52+/-20 ml/min nonpreemptive; P=0.37).
  
  
  CONCLUSIONS
  With prompt referral and workup, preemptive kidney transplantation can be performed successfully in a large percentage of renal allograft recipients. Preemptive transplantation avoids unnecessary dialysis and should be emphasized as initial therapy for many patients with end-stage renal disease.
authors.affiliation: William J. von Liebig Transplant Center, Mayo Clinic and Foundation, Rochester, MN, USA.
authors.forename: Giulio R
authors.initials: GR
authors.lastname: Innocenti
authors.forename: Hani M
authors.initials: HM
authors.lastname: Wadei
authors.forename: Mikel
authors.initials: M
authors.lastname: Prieto
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Dean
authors.forename: Eduardo J
authors.initials: EJ
authors.lastname: Ramos
authors.forename: Stephen
authors.initials: S
authors.lastname: Textor
authors.forename: Hasan
authors.initials: H
authors.lastname: Khamash
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Larson
authors.forename: Fernando
authors.initials: F
authors.lastname: Cosio
authors.forename: Kay
authors.initials: K
authors.lastname: Kosberg
authors.forename: Lynette
authors.initials: L
authors.lastname: Fix
authors.forename: Charise
authors.initials: C
authors.lastname: Bauer
authors.forename: Mark D
authors.initials: MD
authors.lastname: Stegall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007483:Iothalamic Acid; D007668:Kidney / Q000502:physiology; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D007483:Iothalamic Acid