Preemptive Renal Transplantation: Why Not?

Mange, Kevin C.; Weir, Matthew R.

doi:10.1046/j.1600-6143.2003.00232.x

Cited by 54 publications

(36 citation statements)

References 20 publications

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“…Our findings seem to be better than those of other reports. 10,11,29 Because our study group is small, our finding about the effectiveness of pre-emptive kidney transplantation in patients with T1D and ESRD needs to be seen as preliminary. The challenge is how to increase frequency of pre-emptive kidney transplantation in patients with T1D and ESRD.…”

Section: Discussionmentioning

confidence: 96%

“…The challenge is how to increase frequency of pre-emptive kidney transplantation in patients with T1D and ESRD. 11 In the Joslin cohort such transplantation was implemented in 20% of patients who developed ESRD in the 2000s.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Also a strategy of "pre-emptive" renal transplantation has been adopted to avoid dialysis and its associated high mortality. 10,11 Similarly, efforts to reduce cardiovascular mortality through treatment of hypercholesterolemia and hypertension and by encouraging smoking cessation may have reduced mortality both pre-and post-ESRD. Little research has been done to determine the magnitude of the effect of all of these protocols on the course of the advanced stages of diabetic nephropathy in T1D.…”

mentioning

confidence: 99%

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Risk for ESRD in Type 1 Diabetes Remains High Despite Renoprotection

Rosolowsky

Skupień

Smiles

et al. 2011

Journal of the American Society of Nephrology

170

174

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Historically, patients with type 1 diabetes and macroalbuminuria had high competing risks: cardiovascular death or renal failure. Here, we assessed these risks in patients receiving therapies implemented during the last 30 years. Between 1991 and 2004, we enrolled 423 white patients with type 1 diabetes who developed macroalbuminuria (albumin excretion rate, Ն300 g/min). With follow-up for 98% through 2008, ESRD developed in 172 patients (incidence rate, 5.8/100 person-years), and 29 died without ESRD (mortality rate, 1/100 person-years). The majority of these outcomes occurred between ages 36 and 52 years with durations of diabetes of 21 to 37 years. The 15-year cumulative risks were 52% for ESRD and 11% for pre-ESRD death. During the 15 years of follow-up, the use of renoprotective treatment increased from 56 to 82%, and BP and lipid levels improved significantly; however, the risks for both ESRD and pre-ESRD death did not change over the years analyzed. There were 70 post-ESRD deaths, and the mortality rate was very similar during the 1990s and the 2000s (11/100 person-years versus 12/100 person-years, respectively). Mortality was low in patients who received a pre-emptive kidney transplant (1/100 person-years), although these patients did not differ from dialyzed patients with regard to predialysis eGFR, sex, age at onset of ESRD, or duration of diabetes. In conclusion, despite the widespread adoption of renoprotective treatment, patients with type 1 diabetes and macroalbuminuria remain at high risk for ESRD, suggesting that more effective therapies are desperately needed.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Risk for ESRD in Type 1 Diabetes Remains High Despite Renoprotection

Rosolowsky

Skupień

Smiles

et al. 2011

Journal of the American Society of Nephrology

170

174

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“…PKT has beter outcomes for both post transplant graft and patient survival and also co-morbidities happening during a dialysis period (10,11). Mange et al showed improved graft survival of PKT in 8481 living donor transplantation with 52% decrease for graft loss for PKT over non preemptive (12). Kasiske et al found similar results for both living and deceased donor transplantation (13).…”

Section: Introductionmentioning

confidence: 93%

Preemptive Kidney Transplantation

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2011

Understanding the Complexities of Kidney Transplantation

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“…In 2005, 2.3% of incident ESRD patients underwent preemptive transplantation, whereas the remaining patients started dialysis treatment (2). The progression from advanced CKD to dialysis, rather than to preemptive transplantation, can be attributed to a number of system and physician barriers such as late nephrology referral, UNOS requirements that creatinine clearance be Ͻ20 ml/min before a patient may be placed on the deceased donor kidney transplantation wait list, time to complete the medical evaluation for transplantation, or lack of timely availability of a kidney, whether from a deceased or live kidney donor (8,(17)(18)(19)(20)(21). Uncertainty regarding the optimal level of impaired kidney function at which the transplant should be performed and the possibility that preemptive transplant patients' adherence to immunosuppressive medications might be reduced compared with those who experience the hardships of dialysis therapy before transplantation also concern nephrologists (10).…”

mentioning

confidence: 99%

A Survey of Nephrologists’ Views on Preemptive Transplantation

Pradel

Jain

Mullins

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: Despite emerging evidence that preemptive transplantation is the best treatment modality for patients reaching end-stage renal disease (ESRD), it is underutilized. Nephrologists' views on preemptive transplantation are explored herein.Design, setting, participants, & measurements: A web-based survey elicited barriers to preemptive transplantation as perceived by nephrologists as well as demographic and practice variables associated with a favorable attitude toward preemptive transplantation.Results: Four hundred seventy-six of 5,901 eligible nephrologists responded (8% participation rate). Seventy-one percent of respondents agreed that preemptive transplantation is the best treatment modality for eligible chronic kidney disease (CKD) patients reaching ESRD, 69% reported that late referrals did not allow enough time for patients to be evaluated for preemptive transplantation, and 50% stated that there was too much delay between a patient's referral and the time the patient was seen at the transplant center. Nephrologists agreed to a lesser extent that they should be held accountable for CKD patients' education (26%) and preemptive transplant referrals (23%). The most important patient factors considered when deciding not to discuss preemptive transplant were poor health status (70%), lack of compliance (69%), other medical problems (51%), being too old (40%), lack of prescription coverage (37%), and lack of health insurance to cover the costs of the procedure (36%).Conclusions: Surveyed nephrologists consider preemptive transplantation as the optimal treatment modality for eligible patients. Late referral, patient health and insurance status, and delayed transplant center evaluation are perceived as major barriers to preemptive transplantation.

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Preemptive Renal Transplantation: Why Not?

Cited by 54 publications

References 20 publications

Risk for ESRD in Type 1 Diabetes Remains High Despite Renoprotection

Risk for ESRD in Type 1 Diabetes Remains High Despite Renoprotection

Preemptive Kidney Transplantation

A Survey of Nephrologists’ Views on Preemptive Transplantation

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