title: Preemptive kidney transplantation: experience in two centers.
abstract: BACKGROUND
  End-stage renal disease (ESRD) is a prevalent, important cause of death. Transplantation increases survival and improves the quality of life of patients with ESRD while long-term dialysis is related to poor outcomes even among patients who undergo subsequent transplantations.
  
  
  OBJECTIVE
  To compare the advantages of preemptive procedures with kidney transplants among patients on renal replacement therapy.
  
  
  METHODS
  This retrospective study was performed in two Córdoba city transplantation centers. Patients were divided into three groups: preemptive kidney transplant (PKT), patients on hemodialysis who received living donor kidney transplants (LDT), and subjects who received grafts from deceased donors (DDT). Serum creatinine, delayed graft function (DGF), subclinical rejection, and interstitial fibrosis/tubular atrophy (IF/TA) were evaluated at 6 months.
  
  
  RESULTS
  Eighty patients were included: PKT (n = 28), LDT (n = 27), DDT (n = 25) mean age 29, 30, and 35 years, respectively. Women predominated among PKT and men in the other groups. In all groups, cyclosporine was the calcineurin inhibitor mostly used. Creatinine at 6 months was lower in the living donor groups (1.26 mg/dL PKT and 1.32 mg/dL LDT; P = NS) in relation to the deceased donor group (1.96 mg/dL; P < .05). DDT had the highest rate of DGF: 44% DDT versus 11.5% LDT vs 0% PKT (P < .05). Subclinical rejection was significantly lower among preemptive transplantations: PKT 7.6% versus LDT 18.5% versus DDT 24% (P < .05). IF/TA was higher in transplants from deceased donors: PKT 11.1%; LDT 11.5%; DDT 32%.
  
  
  CONCLUSIONS
  Preemptive kidney transplantation offered the advantages of a lower creatinine, no DGF, as well as a reduced incidence of subclinical rejection and chronic allograft nephropathy at 6 months posttransplantation.
authors.affiliation: Department of Nephrology, Sanatorio Allende, Córdoba City, Argentina. diegohrigo@gmail.com
authors.forename: D H
authors.initials: DH
authors.lastname: Rigo
authors.forename: L
authors.initials: L
authors.lastname: Ziraldo
authors.forename: L
authors.initials: L
authors.lastname: Di Monte
authors.forename: M P
authors.initials: MP
authors.lastname: Jimenez
authors.forename: A P
authors.initials: AP
authors.lastname: Giotto
authors.forename: L
authors.initials: L
authors.lastname: Gutierrez
authors.forename: I
authors.initials: I
authors.lastname: Rodriguez
authors.forename: M
authors.initials: M
authors.lastname: Orias
authors.forename: P A
authors.initials: PA
authors.lastname: Novoa
mesh_terms: D000328:Adult; D019703:Calcineurin / Q000494:pharmacology; D016572:Cyclosporine / Q000494:pharmacology; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D006435:Renal Dialysis; D017582:Renal Replacement Therapy / Q000379:methods; D012189:Retrospective Studies; D009927:Tissue and Organ Procurement / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D016572:Cyclosporine; D019703:Calcineurin