title: Preemptive kidney transplant from deceased donors: an advantage in relation to reduced waiting list.
abstract: BACKGROUND
  Preemptive living donor kidney transplantation is associated with better allograft and recipient survival. However, it remains unclear whether preemptive transplantation from deceased donors is beneficial too. An increased number of deceased donors has reduced the waiting list in our hospital in the last years allowing preemptive deceased donor kidney transplantation (PDDKT).
  
  
  OBJECTIVE
  We compared our experience with preemptive transplantation with patients who underwent dialysis before transplantation.
  
  
  METHODS
  Thirty-three PDDKT, including 77.5% male patients of overall mean age of 48 +/- 14 years, were performed in our hospital between January 1999 and December 2004 (8% of transplantations). We compared the outcomes of these patients with those of renal transplants in subjects who had undergone dialysis. The donors for both groups had similar characteristic; they were paired donor kidneys in most cases.
  
  
  RESULTS
  The types of donors in both groups were: non-heart-beating (49%), heart-beating deceased (27%) or en bloc pediatric (24%). The serum creatinine of the recipients was 6.9 +/- 1.8 mg/dL prior to transplantation, and the creatinine clearance was 14.6 +/- 3.6 mL/min (estimated by the Cockroft-Gault formula). The Charlson comorbidity index adapted for patients with advanced chronic kidney disease (ACKD) was 0.8 +/- 0.2 in the preemptive group versus 1.7 +/- 0.4 in the dialysis group (P < .05). Delayed graft function rates were 0% versus 25% in preemptive vs dialysis groups, respectively. No differences in 1-month or 1-year renal function as determined by serum creatinine were observed between the groups. We did not observe differences in the incidence of acute rejection or 1- and 2-year graft and patient survivals.
  
  
  CONCLUSIONS
  PDDKT is the treatment of choice for ACKD. It is associated with less delayed graft function and similar 2-year graft and patient survivals than kidney transplantation after dialysis. The Charlson index reflected less comorbidity among patients with PDDKT, a finding that must influence long-term outcomes.
authors: Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain.
authors: I
authors: I
authors: Pérez-Flores
authors: A
authors: A
authors: Sánchez-Fructuoso
authors: N
authors: N
authors: Calvo
authors: M
authors: M
authors: Marques
authors: S
authors: S
authors: Anaya
authors: N
authors: N
authors: Ridao
authors: A
authors: A
authors: Rodríguez
authors: A
authors: A
authors: Barrientos
mesh_terms: D000328:Adult; D002102:Cadaver; D002648:Child; D003404:Creatinine / Q000097:blood; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods* / Q000502:physiology*; D019520:Living Donors; D008875:Middle Aged; D018579:Patient Selection; D006435:Renal Dialysis; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D003404:Creatinine