title: Does pre-emptive kidney transplantation with a deceased donor improve outcomes? Results from a French transplant network.
abstract: Large analyses have demonstrated that pre-emptive kidney transplantation (PKT) leads to significant improvements in patient and graft survival when compared with transplantation performed after a period of dialysis. We analysed 1585 patients who received a first renal transplantation from a deceased donor between 2000 and 2004 in four French transplantation centres. The objective was to compare the characteristics of the deceased donor transplantations with or without previous dialysis and to evaluate the impact of PKT and length of dialysis on patient and graft outcomes. Mean age of recipients was 48.1 ± 13.4 years, 62% were men, and 118 (7.4%) of them received a pre-emptive transplantation. For the nonpre-emptive patients, mean time on pretransplant dialysis was 3.4 ± 3.2 years. Pretransplant factors independently related to pre-emptive transplantation were year of transplantation, centre and recipients characteristics: gender, diabetes history, blood group and donor age. Patients with pretransplant dialysis were three times more likely to have delayed graft function than pre-emptive transplant patients, and were 10 times more likely to receive post-transplant dialysis. Five-year patient survival was 92.9%. Five-year graft survival was 89.0%. Neither pre-emptive transplantation nor time on dialysis was significantly associated with patient and/or graft survival.
authors.affiliation: Department of Nephrology, University Hospital Nancy, France. m.kessler@chu-nancy.fr
authors.forename: Michèle
authors.initials: M
authors.lastname: Kessler
authors.forename: Marc
authors.initials: M
authors.lastname: Ladriere
authors.forename: Magali
authors.initials: M
authors.lastname: Giral
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Soulillou
authors.forename: Christophe
authors.initials: C
authors.lastname: Legendre
authors.forename: Franck
authors.initials: F
authors.lastname: Martinez
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.forename: François
authors.initials: F
authors.lastname: Alla
mesh_terms: D000328:Adult; D002102:Cadaver; D051799:Delayed Graft Function; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome