Preemptive living donor kidney transplantation: Do the benefits extend to all recipients?

Giulio R. Innocenti, Hani M. Wadei, Mikel Prieto, Patrick G. Dean, Eduardo J. Ramos, Stephen C Textor, Hasan Khamash, Timothy S. Larson, Fernando G Cosio, Kay Kosberg, Lynette Fix, Charise Bauer, Mark D Stegall

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

BACKGROUND. Preemptive kidney transplantation (prior to the institution of dialysis) avoids the morbidity and mortality of dialysis; however, detailed studies of high-risk patients are lacking. The aim of the current study was to compare recent outcomes of preemptive (P) versus nonpreemptive (NP) living donor kidney transplantation with an emphasis on high-risk recipients. METHODS. We retrospectively analyzed 438 sequential solitary living donor kidney transplants at our institution between January 2000 and December 2002. In all, 44% were preemptive. NP recipients were dialyzed for 21±36 months (range 1-312 months). RESULTS. Overall, three-year patient survival was similar in the NP and P groups. When stratified by diabetes and age >65 years, P and NP recipients again showed similar survival. Death-censored three-year graft survival was better in the P group (97% vs. 90%, P=0.01), but was not significant by multivariate analysis. Delayed graft function was more frequent in NP vs. P (10% vs. 4%; P=0.01), but other early complications were similar including: acute rejection, 16% vs. 11% (P=0.11); primary nonfunction, 3% vs. 2% (P=0.38); and wound complications, 19% vs. 17% (P=0.54). Glomerular filtration rate at three years was similar in the two groups (53±23 preemptive vs. 52±20 ml/min nonpreemptive; P=0.37). CONCLUSION. 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.

Original languageEnglish (US)
Pages (from-to)144-149
Number of pages6
JournalTransplantation
Volume83
Issue number2
DOIs
StatePublished - Jan 2007

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Living Donors
Kidney Transplantation
Dialysis
Delayed Graft Function
Kidney
Survival
Graft Survival
Glomerular Filtration Rate
Chronic Kidney Failure
Allografts
Referral and Consultation
Multivariate Analysis
Transplantation
Morbidity
Transplants
Mortality
Wounds and Injuries
Therapeutics

Keywords

  • Dialysis
  • Graft survival
  • Kidney transplantation
  • Living donation
  • Postoperative complications

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Preemptive living donor kidney transplantation : Do the benefits extend to all recipients? / Innocenti, Giulio R.; Wadei, Hani M.; Prieto, Mikel; Dean, Patrick G.; Ramos, Eduardo J.; Textor, Stephen C; Khamash, Hasan; Larson, Timothy S.; Cosio, Fernando G; Kosberg, Kay; Fix, Lynette; Bauer, Charise; Stegall, Mark D.

In: Transplantation, Vol. 83, No. 2, 01.2007, p. 144-149.

Research output: Contribution to journalArticle

Innocenti, GR, Wadei, HM, Prieto, M, Dean, PG, Ramos, EJ, Textor, SC, Khamash, H, Larson, TS, Cosio, FG, Kosberg, K, Fix, L, Bauer, C & Stegall, MD 2007, 'Preemptive living donor kidney transplantation: Do the benefits extend to all recipients?', Transplantation, vol. 83, no. 2, pp. 144-149. https://doi.org/10.1097/01.tp.0000250555.46539.65
Innocenti, Giulio R. ; Wadei, Hani M. ; Prieto, Mikel ; Dean, Patrick G. ; Ramos, Eduardo J. ; Textor, Stephen C ; Khamash, Hasan ; Larson, Timothy S. ; Cosio, Fernando G ; Kosberg, Kay ; Fix, Lynette ; Bauer, Charise ; Stegall, Mark D. / Preemptive living donor kidney transplantation : Do the benefits extend to all recipients?. In: Transplantation. 2007 ; Vol. 83, No. 2. pp. 144-149.
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abstract = "BACKGROUND. Preemptive kidney transplantation (prior to the institution of dialysis) avoids the morbidity and mortality of dialysis; however, detailed studies of high-risk patients are lacking. The aim of the current study was to compare recent outcomes of preemptive (P) versus nonpreemptive (NP) living donor kidney transplantation with an emphasis on high-risk recipients. METHODS. We retrospectively analyzed 438 sequential solitary living donor kidney transplants at our institution between January 2000 and December 2002. In all, 44{\%} were preemptive. NP recipients were dialyzed for 21±36 months (range 1-312 months). RESULTS. Overall, three-year patient survival was similar in the NP and P groups. When stratified by diabetes and age >65 years, P and NP recipients again showed similar survival. Death-censored three-year graft survival was better in the P group (97{\%} vs. 90{\%}, P=0.01), but was not significant by multivariate analysis. Delayed graft function was more frequent in NP vs. P (10{\%} vs. 4{\%}; P=0.01), but other early complications were similar including: acute rejection, 16{\%} vs. 11{\%} (P=0.11); primary nonfunction, 3{\%} vs. 2{\%} (P=0.38); and wound complications, 19{\%} vs. 17{\%} (P=0.54). Glomerular filtration rate at three years was similar in the two groups (53±23 preemptive vs. 52±20 ml/min nonpreemptive; P=0.37). CONCLUSION. 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.",
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T2 - Do the benefits extend to all recipients?

AU - Innocenti, Giulio R.

AU - Wadei, Hani M.

AU - Prieto, Mikel

AU - Dean, Patrick G.

AU - Ramos, Eduardo J.

AU - Textor, Stephen C

AU - Khamash, Hasan

AU - Larson, Timothy S.

AU - Cosio, Fernando G

AU - Kosberg, Kay

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AU - Stegall, Mark D

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N2 - BACKGROUND. Preemptive kidney transplantation (prior to the institution of dialysis) avoids the morbidity and mortality of dialysis; however, detailed studies of high-risk patients are lacking. The aim of the current study was to compare recent outcomes of preemptive (P) versus nonpreemptive (NP) living donor kidney transplantation with an emphasis on high-risk recipients. METHODS. We retrospectively analyzed 438 sequential solitary living donor kidney transplants at our institution between January 2000 and December 2002. In all, 44% were preemptive. NP recipients were dialyzed for 21±36 months (range 1-312 months). RESULTS. Overall, three-year patient survival was similar in the NP and P groups. When stratified by diabetes and age >65 years, P and NP recipients again showed similar survival. Death-censored three-year graft survival was better in the P group (97% vs. 90%, P=0.01), but was not significant by multivariate analysis. Delayed graft function was more frequent in NP vs. P (10% vs. 4%; P=0.01), but other early complications were similar including: acute rejection, 16% vs. 11% (P=0.11); primary nonfunction, 3% vs. 2% (P=0.38); and wound complications, 19% vs. 17% (P=0.54). Glomerular filtration rate at three years was similar in the two groups (53±23 preemptive vs. 52±20 ml/min nonpreemptive; P=0.37). CONCLUSION. 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.

AB - BACKGROUND. Preemptive kidney transplantation (prior to the institution of dialysis) avoids the morbidity and mortality of dialysis; however, detailed studies of high-risk patients are lacking. The aim of the current study was to compare recent outcomes of preemptive (P) versus nonpreemptive (NP) living donor kidney transplantation with an emphasis on high-risk recipients. METHODS. We retrospectively analyzed 438 sequential solitary living donor kidney transplants at our institution between January 2000 and December 2002. In all, 44% were preemptive. NP recipients were dialyzed for 21±36 months (range 1-312 months). RESULTS. Overall, three-year patient survival was similar in the NP and P groups. When stratified by diabetes and age >65 years, P and NP recipients again showed similar survival. Death-censored three-year graft survival was better in the P group (97% vs. 90%, P=0.01), but was not significant by multivariate analysis. Delayed graft function was more frequent in NP vs. P (10% vs. 4%; P=0.01), but other early complications were similar including: acute rejection, 16% vs. 11% (P=0.11); primary nonfunction, 3% vs. 2% (P=0.38); and wound complications, 19% vs. 17% (P=0.54). Glomerular filtration rate at three years was similar in the two groups (53±23 preemptive vs. 52±20 ml/min nonpreemptive; P=0.37). CONCLUSION. 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.

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