title: Pre-emptive pediatric kidney transplantation or not?
abstract: BACKGROUND
  Kidney transplantation prior to dialysis (pre-emptive kidney transplantation, PKT) has been controversial because of the paucity of clinical evidence to clarify the risks and benefits of PKT. Several authors have confirmed a significant advantage of PKT in the treatment of patients with end-stage renal disease (ESRD). The aim of this study was to examine the characteristics of patients who received PKT or non-pre-emptive kidney transplant (NPKT).
  
  
  METHODS
  We used a cohort of 323 consecutive kidney-transplanted children (53% boys) from Hospital da Criança Santo Antonio, Porto Alegre, Brazil, who underwent transplantation between January 2000 and December 2010.
  
  
  RESULTS
  The main causes of ESRD were congenital anomalies of the kidney and urinary tract (CAKUT) (39%) and glomerulopathies (27.5%). The 12-, 36-, 60-, and 90-months death-censored graft survival rates were 97%, 92%, 86%, and 76%, respectively, in the PKT group, and 87%, 79%, 72%, and 65% in the NPKT group (P < .05).
  
  
  CONCLUSIONS
  The results of this study suggest that pre-emptive transplantation is beneficial (hazard ratio = 0.37; 95% confidence interval: 0.18-0.82). The main causes of graft loss (n = 67) were recurrence of primary disease (21%), chronic allograft injury (17%), and death with a functioning graft (16%). We recommend PKT as a better choice for transplantation whenever possible to minimize ESRD morbidity and provide better long-term patient and graft survival.
authors.affiliation: Pediatric Nephrology Unit, Departament of Nephrology, Hospital da Criança Santo Antonio, Santa Casa Porto Alegre, Brazil; Nephrology Department, Universidade Federal Ciências da Saude Porto Alegre, Porto Alegre, Brazil. Electronic address: cdruckgarcia@gmail.com.
authors.forename: C D
authors.initials: CD
authors.lastname: Garcia
authors.affiliation: Pediatric Nephrology Unit, Departament of Nephrology, Hospital da Criança Santo Antonio, Santa Casa Porto Alegre, Brazil.
authors.forename: V B
authors.initials: VB
authors.lastname: Bittencourt
authors.affiliation: Pediatric Nephrology Unit, Departament of Nephrology, Hospital da Criança Santo Antonio, Santa Casa Porto Alegre, Brazil.
authors.forename: R W
authors.initials: RW
authors.lastname: Rohde
authors.affiliation: Pediatric Nephrology Unit, Departament of Nephrology, Hospital da Criança Santo Antonio, Santa Casa Porto Alegre, Brazil.
authors.forename: S
authors.initials: S
authors.lastname: Dickel
authors.affiliation: Pediatric Nephrology Unit, Departament of Nephrology, Hospital da Criança Santo Antonio, Santa Casa Porto Alegre, Brazil.
authors.forename: I
authors.initials: I
authors.lastname: Pires
authors.affiliation: Pediatric Nephrology Unit, Departament of Nephrology, Hospital da Criança Santo Antonio, Santa Casa Porto Alegre, Brazil.
authors.forename: K
authors.initials: K
authors.lastname: Tumba
authors.affiliation: Transplant Unit, Hospital Dom Vicente Scherer, Santa Casa Porto Alegre, Porto Alegre, Brazil.
authors.forename: S P
authors.initials: SP
authors.lastname: Vitola
authors.affiliation: Universidade de Caxias do Sul, Brazil; Programa de Pós graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: V
authors.initials: V
authors.lastname: de Souza
authors.affiliation: Programa de Pós graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Wagner
authors.affiliation: Transplant Unit, Hospital Dom Vicente Scherer, Santa Casa Porto Alegre, Porto Alegre, Brazil.
authors.forename: V D
authors.initials: VD
authors.lastname: Garcia
mesh_terms: D000293:Adolescent; D001938:Brazil; D002648:Child; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D013997:Time Factors; D014184:Transplantation, Homologous; D019737:Transplants; D014564:Urogenital Abnormalities / Q000150:complications