Preemptive transplantation and the transplant first initiative.
OBJECTIVE
Preemptive kidney transplant (PKT) is the focus of a new initiative, 'Transplant First'. This initiative focuses on increasing patient transition to transplantation prior to the need for dialysis. This review will evaluate the benefits of PKT and means to accomplish this goal.


RESULTS
Outcomes data show PKT significantly improves long-term survival for the recipient and the allograft. In addition quality of life is improved. This also holds true for children and particularly for adolescents. In 2008, 5.7% of incident patients with end-stage renal disease were placed on the waiting list before beginning dialysis and 0.8% underwent preemptive living donor transplant before wait listing. If patients are evaluated before starting dialysis and are acceptable candidates, up to 40% will receive a preemptive transplant. Recent articles stress that patients want information from their physician; important impediments to PKT remain provider and patient education, insurance coverage and patient reluctance to ask for living donation.


CONCLUSIONS
Preemptive transplant saves lives. Increased education focused on providers, patients and entire communities is key, as is an increase in living donation. Furthermore, to maximize the impact of transplant first, increased living donor protections and immunosuppression coverage for the life of the allograft are essential.
Davis
Connie L
CL
Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA. cdavis@nephrology.washington.edu
D000293:Adolescent; D000328:Adult; D002648:Child; D006085:Graft Survival; D006297:Health Services Accessibility; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors; D016730:Program Development; D011788:Quality of Life; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
D007166:Immunosuppressive Agents