title: Advantages of kidney transplant precocity in graft long-term survival.
abstract: BACKGROUND
  Preemptive kidney transplantation (KT) or KT after a brief period on dialysis (<6 months) has been associated with better graft survival. Our study aimed to analyze the effect of an early KT on graft survival censored for patient death with functioning graft.
  
  
  METHODS
  A total of 1,373 kidney-only transplantations, from both living and deceased donors, performed from 1983 to 2010 were retrospectively studied. We defined 2 groups: those with early KT (preemptive or within 6 months after dialysis initiation; n = 131) and non-early KT (n = 1,242). Survival curves for each group were calculated by Kaplan-Meier analysis and compared by log-rank test. The independent effect of early KT on censored graft survival was analyzed by a multivariate-adjusted Cox proportional regression model.
  
  
  RESULTS
  The 5-, 10-, 15-, and 20-year censored graft survival rates were, respectively, 96%, 89%, 79%, and 79% among the early KT group, and 91%, 81%, 68%, and 49% among the non-early KT group (P = .024). Multivariate analysis showed the following to be independent predictors for censored graft failure: non-early KT (hazard ratio [HR] 2.58; P = .028), recipient age (HR 0.97; P < .001), donor age (HR 1.03; P < .001), recipient negative status for cytomegalovirus IgG (HR 1.44; P = .032), delayed graft function (HR 1.48; P = .013), and acute rejection event (HR 1.68; P = .002).
  
  
  CONCLUSIONS
  Our results show that early KT can be an approach for the improvement of long-term graft survival.
authors.affiliation: Serviço de Nefrologia, Hospital Santo António, Porto, Portugal. anabelamalho@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Malho
authors.forename: J
authors.initials: J
authors.lastname: Malheiro
authors.forename: I
authors.initials: I
authors.lastname: Fonseca
authors.forename: L S
authors.initials: LS
authors.lastname: Martins
authors.forename: S
authors.initials: S
authors.lastname: Pedroso
authors.forename: M
authors.initials: M
authors.lastname: Almeida
authors.forename: L
authors.initials: L
authors.lastname: Dias
authors.forename: A
authors.initials: A
authors.lastname: Castro Henriques
authors.forename: A
authors.initials: A
authors.lastname: Cabrita
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D051799:Delayed Graft Function / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000517:prevention & control*; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome