Experience from an active preemptive kidney transplantation program--809 cases revisited.
BACKGROUND
Preemptive kidney transplantation (PKT) is increasingly acknowledged. We wanted to investigate the results of an active PKT policy in an unselected end-stage renal disease population with high prevalence of PKT.


METHODS
From 1989 to 2007, 3400 first kidney transplantations were performed in which 809 were PKTs (24%). PKT patients were 7.4 years younger (P<0.001), had more live donors (LD; 64% vs. 35%, P<0.001), and fewer were panel reactive human leukocyte antigen antibody positive (2% vs. 6%, P<0.001).


RESULTS
In the Cox regression analyses of patient mortality, uncensored and death-censored graft failures, all potential risk factors tested were statistically significant, except for recipient sex (i.e., recipient and donor age, PKT, deceased donor [DD], diabetes nephropathy, human leukocyte antigen-DR mismatch, and panel reactive antibody positivity). For patient mortality, PKT and DD had a hazard ratio (HR) of 0.75 (P=0.001) and 1.38 (P<0.001), respectively. The results were similar for uncensored and death-censored graft failures. Risk analyses were also performed separately for DD and LD cohorts. The results were comparable, except that PKT was not a significant risk factor in the LD cohort (HR=0.82, P=0.12 for mortality and HR=0.83, P=0.051 for uncensored graft failure). However, in DD recipients, patient mortality (HR=0.70, P=0.004) and uncensored graft failure (HR=0.68, P<0.001) were significantly reduced with PKT.


CONCLUSIONS
PKT reduced the risk of patient mortality and uncensored graft failure in DD recipients. Our study confirms the advantages of PKT in an unselected end-stage renal disease population with a high prevalence of PKT.
Witczak
Bartlomiej J
BJ
Department of Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Oslo, Norway. b.j.witczak@medisin.uio.no
Leivestad
Torbjørn
T
Line
Pål Dag
PD
Holdaas
Hallvard
H
Reisaeter
Anna V
AV
Jenssen
Trond G
TG
Midtvedt
Karsten
K
Bitter
Jan
J
Hartmann
Anders
A
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D012306:Risk; D013997:Time Factors
D006680:HLA Antigens