Preemptive Living Donor Kidney Transplantation: Do the Benefits Extend to All Recipients?

Abstract

With prompt referral and workup, preemptive kidney transplantation can be performed successfully in a large percentage of renal allograft recipients. Preemptive transplantation avoids unnecessary dialysis and should be emphasized as initial therapy for many patients with end-stage renal disease.

Cardiac Troponin T Before and After Kidney Transplantation: Determinants and Implications for Posttransplant Survival

“…The search for variables related to elevated cTnT suggest potential targets for preventive or therapeutic intervention one of which is avoidance or minimization of dialysis pretransplant as dialysis relates to marked increase in cTnT pre (9) and persistent elevation posttransplant. It is well established that time on dialysis pretransplant relates to posttransplant survival (27,28) and that preemptive transplantation is beneficial (29)(30)(31). Moreover, our results show a strong association between kidney allograft function and cTnT levels.…”

Kidney Transplantation as Primary Therapy for End-Stage Renal Disease

“…Overall, costs attributable to maintenance of a kidney transplant are less than one third those that are associated with long-term dialysis. It is now clear that transplants performed preemptively reduce the frequency of costly complications such as delayed graft function, acute rejection, and allograft failure (10,16). Although available estimates remain inexact, it is likely that by also avoiding the initiation of dialysis with its attendant complications, preemptive transplantation imparts substantial cost savings to the Medicare ESRD program.…”

“…It is now well established that early kidney transplantation is associated with optimal outcomes in terms of patient and graft survival (7)(8)(9)(10). Not as widely appreciated is the potential salutary impact of preemptive transplantation on peaks (in cost, morbidity, and mortality) and valleys (in employability and quality of life) that occur with transitions in CKD care (5) (Figures 1 and 2).…”

Association of Dialysis Duration with Outcomes after Transplantation in a Japanese Cohort

“…Although many studies conducted before 2000 reported improved graft and patient survival with PKT (3-5), recent studies have suggested that these benefits are limited to PKTs that use grafts from DDs (6,(18)(19)(20). One study reported no benefit on graft survival between PKT and non-PKT using grafts from LDs after a median dialysis period of 25.6 months (7).…”