Is preemptive kidney transplantation preferred? Updated study.
BACKGROUND
For eligible patients with end-stage renal disease, the dialysis stage could be bypassed by preemptive kidney transplantation (PKT), when the organ is available. We compared this treatment option with kidney transplantation in patients with pretransplant dialysis (PTD).


METHODS
We retrospectively studied on 300 patients who received PKT between 1992 and 2006 from living donors. They were compared with 300 kidney recipients with PTD matched for the time of transplantation that had been on hemodialysis for at least 6 months. Episodes of rejection, graft function, and graft and patient survivals were compared between the two groups.


RESULTS
No significant differences were noted in the sex of the recipients, age and sex of the donors, donor source, and posttransplant immunosuppressive therapy, but posttransplant follow-up was longer (P < .001) and the recipients were older (P < .001) in the PTD group. Seventy-one patients (23.7%) in the PKT group and 64 (21.3%) in the PTD had at least 1 rejection (P = .49). The kidney allografts were functional in 272 (90.7%) kidney recipients in the PKT group and 278 (92.7%) in the PTD group during their follow-ups (P = .30). Five-year graft and patient survival rates were slightly higher in the PTD group, which were not statistically significant (P = .06 and P = .07, respectively).


CONCLUSIONS
In addition to comparable patient and grretroper aft survivals with the PKT and kidney transplantations after a period of dialysis, PKT eliminates hemodialysis costs and complications. We recommend PKT as a better choice for transplantation whenever possible.
Pour-Reza-Gholi
Fatemeh
F
Department of Kidney Transplantation, Shaheed Labbafinejad Medical Center, Tehran, Iran. poorreza@hotmail.com
Nafar
Mohsen
M
Simforoosh
Naser
N
Einollahi
Behzad
B
Basiri
Abbas
A
Firouzan
Ahmad
A
Alipour Abedi
Behrang
B
Farhangi
Soudabeh
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D006435:Renal Dialysis; D012189:Retrospective Studies