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Rana Magar R, Knight SR, Maggiore U, Lafranca JA, Dor FJMF, Pengel LHM. What are the benefits of preemptive versus non-preemptive kidney transplantation? A systematic review and meta-analysis. Transplant Rev (Orlando) 2023; 37:100798. [PMID: 37801855 DOI: 10.1016/j.trre.2023.100798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023]
Abstract
Opting for a preemptive kidney transplant (PKT) can help avoid costs and morbidity associated with dialysis. However, while multiple studies have shown clinical benefits of PKT, other studies have not demonstrated this, leading to controversy in the literature regarding the exact benefits of PKT. Therefore, this study aimed to determine the clinical outcomes of PKT versus non-preemptive kidney transplantation (nPKT) in adult patients. Multiple databases were searched up to May 4, 2022. Independent reviewers selected studies for inclusion and extracted relevant data. Risk of bias was assessed using the Downs and Black checklist. Eighty-seven studies including 859,715 adult kidney transplant patients were included the review. The risk of patient death (relative risk [95% confidence interval] 0.74 [0.60-0.91]) was significantly lower in PKT versus nPKT patients for living donor (LD) transplants, whereas the risk of overall graft loss was significantly lower in PKT compared to nPKT patients for both LD (0.72 [0.62-0.83]) as well as deceased donor (DD) transplants (0.80 [0.69-0.92]). The evidence suggests that LD PKT patients have a lower risk of patient death and graft loss compared to nPKT patients, and DD PKT patients have a lower risk of graft loss than nPKT patients.
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Affiliation(s)
- Reshma Rana Magar
- Peter Morris Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Simon R Knight
- Peter Morris Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Umberto Maggiore
- Department of Medicine and Surgery, University of Parma, Nephrology Operating Unit, University Hospital, Parma, Italy
| | - Jeffrey A Lafranca
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| | - Frank J M F Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Liset H M Pengel
- Peter Morris Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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2
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Kim J, Lee KW, Kim K, Kang H, Yang J, Park JB, Kim G. Factors to consider during anesthesia in patients undergoing preemptive kidney transplantation: a propensity-score matched analysis. BMC Anesthesiol 2023; 23:263. [PMID: 37543574 PMCID: PMC10403880 DOI: 10.1186/s12871-023-02208-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/15/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND International guidelines have recommended preemptive kidney transplantation (KT) as the preferred approach, advocating for transplantation before the initiation of dialysis. This approach is advantageous for graft and patient survival by avoiding dialysis-related complications. However, recipients of preemptive KT may undergo anesthesia without the opportunity to optimize volume status or correct metabolic disturbances associated with end-stage renal disease. In these regard, we aimed to investigate the anesthetic events that occur more frequently during preemptive KT compared to nonpreemptive KT. METHODS This is a single-center retrospective study. Of the 672 patients who underwent Living donor KT (LDKT), 388 of 519 who underwent nonpreemptive KT were matched with 153 of 153 who underwent preemptive KT using propensity score based on preoperative covariates. The primary outcome was intraoperative hypotension defined as area under the threshold (AUT), with a threshold set at a mean arterial blood pressure below 70 mmHg. The secondary outcomes were intraoperative metabolic acidosis estimated by base excess and serum bicarbonate, electrolyte imbalance, the use of inotropes or vasopressors, intraoperative transfusion, immediate graft function evaluated by the nadir creatinine, and re-operation due to bleeding. RESULTS After propensity score matching, we analyzed 388 and 153 patients in non-preemptive and preemptive groups. The multivariable analysis revealed the AUT of the preemptive group to be significantly greater than that of the nonpreemptive group (mean ± standard deviation, 29.7 ± 61.5 and 14.5 ± 37.7, respectively, P = 0.007). Metabolic acidosis was more severe in the preemptive group compared to the nonpreemptive group. The differences in the nadir creatinine value and times to nadir creatinine were statistically significant, but clinically insignificant. CONCLUSION Intraoperative hypotension and metabolic acidosis occurred more frequently in the preemptive group during LDKT. These findings highlight the need for anesthesiologists to be prepared and vigilant in managing these events during surgery.
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Affiliation(s)
- Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Kyo Won Lee
- Department of Transplantation Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Keoungah Kim
- Department of Anesthesiology and Pain Medicine, School of Dentistry, Dankook University, Cheonan, Korea
| | - Hyeryung Kang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea
| | - Jaehun Yang
- Department of Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jae Berm Park
- Department of Transplantation Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gaabsoo Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Korea.
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Prezelin-Reydit M, Combe C, Harambat J, Jacquelinet C, Merville P, Couzi L, Leffondré K. Prolonged dialysis duration is associated with graft failure and mortality after kidney transplantation: results from the French transplant database. Nephrol Dial Transplant 2019; 34:538-545. [PMID: 29579221 DOI: 10.1093/ndt/gfy039] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 01/19/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Kidney transplantation (KT) is the treatment of choice for end-stage renal disease. Preemptive KT (PKT) should be considered when glomerular filtration rate is <15 mL/min/1.73 m2 but European reports on the results of PKT and the effect of pretransplant dialysis are scarce. METHODS We analysed all first kidney-only transplants performed in adults in France between 2002 and 2012. A Cox multivariable model was used to investigate the association of PKT and of pretransplant dialysis time with the hazard of graft failure defined as death, return to dialysis or retransplant, whichever occurred first. RESULTS We included 22 345 patients, with a mean ± SD age at KT of 50.5 ± 13.4 years; 61.9% were men and 3112 (14.0%) received a PKT. Median time of follow-up was 4.7 years. Graft failure occurred in 4952 patients up to 31 December 2013. After adjustment for recipients' age and sex, primary kidney disease, donor type (living or deceased donor, expanded criteria donor), HLA mismatches, cold ischaemia time, centre and year of transplantation, PKT was associated with a decreased hazard of graft failure when compared with pretransplant dialysis [hazard ratio (HR) 0.57; 95% confidence interval (CI) 0.51-0.63], whatever the duration of dialysis, even in the first 6 months. The effect of PKT on the hazard of graft failure was stronger in living kidney donors (HR 0.32; 95% CI 0.19-0.55). CONCLUSIONS In France, PKT was associated with a lower risk of graft failure than KT performed after the initiation of dialysis, whatever the duration of dialysis.
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Affiliation(s)
- Mathilde Prezelin-Reydit
- University of Bordeaux, ISPED, INSERM, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- Service de Néphrologie Transplantation Dialyse Aphérèses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM, Clinical Investigation Center-Clinical Epidemiology-CIC-1401, Bordeaux, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- INSERM U1026, University of Bordeaux, Bordeaux, France
| | - Jérôme Harambat
- University of Bordeaux, ISPED, INSERM, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- INSERM, Clinical Investigation Center-Clinical Epidemiology-CIC-1401, Bordeaux, France
- Pediatric Nephrology Unit, Pellegrin-Enfants Hospital, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Pierre Merville
- Service de Néphrologie Transplantation Dialyse Aphérèses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- CNRS, UMR 5164, University of Bordeaux, Bordeaux, France
| | - Lionel Couzi
- Service de Néphrologie Transplantation Dialyse Aphérèses, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
- CNRS, UMR 5164, University of Bordeaux, Bordeaux, France
| | - Karen Leffondré
- University of Bordeaux, ISPED, INSERM, Bordeaux Population Health Research Center, UMR1219, Bordeaux, France
- INSERM, Clinical Investigation Center-Clinical Epidemiology-CIC-1401, Bordeaux, France
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Irish GL, Chadban S, McDonald S, Clayton PA. Quantifying lead time bias when estimating patient survival in preemptive living kidney donor transplantation. Am J Transplant 2019; 19:3367-3376. [PMID: 31132214 DOI: 10.1111/ajt.15472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/28/2019] [Accepted: 05/04/2019] [Indexed: 01/25/2023]
Abstract
Preemptive kidney transplantation is the preferred initial renal replacement therapy, by avoiding dialysis and reportedly maximizing patient survival. Lead time bias may account for some or all of the observed survival advantage, but the impact of this has not been quantified. Using the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, we included adult recipients of living donor kidney transplants during 1998-2017. Patients were transplanted preemptively (n = 1435) or after receiving up to 6 months of dialysis (n = 712). We created a matched cohort using propensity scores, and accounted for lead time (dialysis and estimated predialysis) using left-truncated Cox models with the primary outcome of patient survival. The median eGFR at transplantation was 6.9 mL/min per 1.73 m2 in the non-pre-emptive, and 9.6 mL/min per 1.73 m2 in the preemptive group. In the matched cohort (n = 1398), preemptive transplantation was not associated with a survival advantage hazard ratio (HR) for preemptive vs non-pre-emptive 1.12 (95% confidence interval [CI] 0.79-1.61). Accounting for lead time moved the point estimates toward a survival disadvantage for preemptive transplantation (eg, HR assuming 4 mL/min per 1.73 m2 /year eGFR decline, 1.21 [0.85, 1.73]), but in all cases the 95% CIs crossed 1. The optimal timing of preemptive living donor kidney transplantation requires further study.
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Affiliation(s)
- Georgina L Irish
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia.,Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Steve Chadban
- Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia.,Kidney Node, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia.,Department of Medicine, University of Adelaide, Adelaide, Australia
| | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia.,Department of Medicine, University of Adelaide, Adelaide, Australia
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Kidney Discard Rates in the United States During American Transplant Congress Meetings. Transplant Direct 2018; 5:e412. [PMID: 30656210 PMCID: PMC6324911 DOI: 10.1097/txd.0000000000000849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 03/04/2018] [Accepted: 10/17/2018] [Indexed: 11/26/2022] Open
Abstract
Supplemental digital content is available in the text. Background Deceased-donor kidney discard rates vary by region, but it is unknown whether discard rates and transplant outcomes vary during the American Transplant Congress (ATC) each year. Methods Using national registry data, we determined rates of kidney discard, delayed graft function, graft failure, and mortality from December 31, 1999, through December 30, 2015, during ATC dates and compared these rates with those on the same days of the week during the 2 weeks before and after the ATC (non-ATC). We used multivariable regression to determine associations between ATC and these outcomes. Results From 7902 donors (1575 ATC; 6327 non-ATC), 12 588 recipients received kidney transplants (2455 ATC; 10 133 non-ATC), and 2666 kidneys were discarded (582 ATC; 2084 non-ATC). Kidneys were more often discarded during ATC (19% vs 17%, P = 0.006; adjusted odds ratio, 1.21; 95% confidence interval, 1.05-1.40). There were no significant differences in donor, transplant, or recipient characteristics by ATC/non-ATC dates or by ATC/non-ATC transplant dates for delayed graft function, graft failure, or mortality. Conclusions On the basis of a 21% increased odds of discard, the ATC itself may result in 5 additional kidney discards during this important conference every year, which suggests the need for innovative staffing or other logistic solutions during these planned meetings.
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Weber NT, Bonani M, Benden C, Schleich A, Fehr T, Mueller TF, Schuurmans MM. Evolution of lung and kidney allograft function in patients receiving kidney after lung transplantation. Clin Transplant 2017; 32. [PMID: 29194767 DOI: 10.1111/ctr.13169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2017] [Indexed: 11/26/2022]
Abstract
Calcineurin inhibitor (CNI) toxicity leads to end-stage renal disease in almost half of long-term survivors after lung transplantation, some of them receiving kidney transplants. Little is known about the outcomes of kidney and lung allograft function following kidney after lung transplantation (KALTPL) in the modern era. We retrospectively analyzed a group of 13 consecutive patients who received a KALTPL with respect to their renal and pulmonary function and immunological evolution over 2 years. We documented a stable evolution of forced expiratory volume in 1 second (FEV1) after KALTPL in most patients as well as an excellent kidney graft during the 2-year follow-up period. In our small cohort, living donations showed a significantly higher estimated glomerular filtration rate compared to deceased donation (75.7 compared to 41.6 mL/min). Patients who received a preemptive KALTPL were more likely to improve their lung function after KALTPL. Four patients developed de novo donor-specific antibodies (DSA) against the kidney graft. There were no DSA against shared antigens from the lung allograft. De novo DSA did not lead to graft loss in any patient. All 13 patients survived the first 24 months after KALTPL.
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Affiliation(s)
- Nina T Weber
- Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Marco Bonani
- Division of Nephrology, University Hospital, Zurich, Switzerland
| | - Christian Benden
- Division of Pulmonology, University Hospital, Zurich, Switzerland
| | | | - Thomas Fehr
- Department of Internal Medicine, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Thomas F Mueller
- Division of Nephrology, University Hospital, Zurich, Switzerland
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7
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Dębska-Ślizień A, Bzoma B, Moszkowska G, Chamienia A, Milecka A, Zadrożny D, Sledziński Z, Rutkowski B. Preemptive kidney transplantation: analysis of kidney grafts from the same donor. Transplant Proc 2014; 46:2654-9. [PMID: 25380888 DOI: 10.1016/j.transproceed.2014.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND From November 2003 to December 2012, in the Gdańsk Center, 64 patients received preemptive transplantation (PET). PET comprised 8% of 794 kidney transplantations performed during this time. The benefits for individual patients and for the health care system are discussed. METHODS This study compares the outcomes of these PET patients who had their kidney pairs transplanted after a variable duration of dialysis (PTD), a total of 51 pairs. RESULTS The mean Charlson comorbidity index was 2.57 vs 3.04 (P > .05) for the PET and PTD groups, respectively. Both groups did not differ significantly with respect to 1-year patient and graft survivals, and incidences of acute rejection. Five (9.8%) PET patients and 20 (39%) PTD patients experienced delayed graft function (P < .05). The graft function (serum creatinine/4p MDRD) 1 year after transplantation was similar in both groups (1.42/53.7 vs 1.43/57.4; mg/dL/mL/min/1.73 m(2)). More PET patients continued normal professional activities or education before and after transplantation (P < .05). CONCLUSIONS Our single-center results confirmed that for both medical and socioeconomic reasons, PET is an optimal mode of renal replacement therapy.
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Affiliation(s)
- A Dębska-Ślizień
- Department of Nephrology, Transplantology, and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland.
| | - B Bzoma
- Department of Nephrology, Transplantology, and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - G Moszkowska
- Department of Clinical Immunology and Transplantology, Medical University of Gdańsk; Gdańsk, Poland
| | - A Chamienia
- Kidney Transplant Regional Waiting List, Department of General Nursing, Faculty of Medical Sciences, Medical University of Gdańsk, Gdańsk, Poland
| | - A Milecka
- Department of General, Endocrine, and Transplant Surgery, Medical University of Gdańsk; Gdańsk, Poland
| | - D Zadrożny
- Department of General, Endocrine, and Transplant Surgery, Medical University of Gdańsk; Gdańsk, Poland
| | - Z Sledziński
- Department of General, Endocrine, and Transplant Surgery, Medical University of Gdańsk; Gdańsk, Poland
| | - B Rutkowski
- Department of Nephrology, Transplantology, and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
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Ahlert M, Kliemt H. Problems of priority change in kidney allocation and beyond. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2013; 14:383-390. [PMID: 22358456 DOI: 10.1007/s10198-012-0382-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 02/02/2012] [Indexed: 05/31/2023]
Abstract
Standardized and transparent priority setting in medicine, desirable as it is, will generally exacerbate inter-temporal equity problems arising from changes in treatment priorities: when can it be fair that the treatment of already waiting patients who would have had priority under an established system should be postponed (withheld) for an extended period of time to advance the treatment of others under a reformed system? The reform of the Eurotransplant system of priority setting in kidney allocation (ETKAS), which is in many respects ideal, is a case in point. To give due weight to new medical knowledge, waiting time after the onset of end state renal failure should change from a priority-enhancing to a priority-reducing factor. Since those who have gained in priority by waiting under the present system would be set back under the new, severe problems of transitional justice must be overcome when responding to advances in medical knowledge. The paper explores conceptually some possible ways of rule change and indicates their general relevance from an ethical and a practical point of view for future problems of medical resource allocation under transparent, standardized priority-setting rules.
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Affiliation(s)
- Marlies Ahlert
- Department of Law and Economics, Martin-Luther-University Halle-Wittenberg, Halle, Saale, Germany.
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9
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Dębska-Ślizień A, Bzoma B, Rutkowski B. Adult pre-emptive kidney transplantation: a paired kidney analysis. Transpl Int 2011; 24:e59-60. [PMID: 21418336 DOI: 10.1111/j.1432-2277.2011.01249.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Kessler M, Ladriere M, Giral M, Soulillou JP, Legendre C, Martinez F, Rostaing L, Alla F. Does pre-emptive kidney transplantation with a deceased donor improve outcomes? Results from a French transplant network. Transpl Int 2010; 24:266-75. [DOI: 10.1111/j.1432-2277.2010.01195.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Haberal M, Karakayali H, Sevmis S, Akbulut S, Colak T, Baskin E, Moray G, Torgay A, Arslan G. Preemptive living donor renal transplantation: a single-center experience. Transplant Proc 2009; 41:2764-7. [PMID: 19765429 DOI: 10.1016/j.transproceed.2009.07.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Renal transplantation is considered preemptive if it occurs before initiation of dialysis. In our experience and in the literature, preemptive transplantation has been shown not only to reduce the costs of renal replacement therapy but also to avoid the long-term adverse effects of dialysis. Preemptive renal transplantation therefore is associated with better survival of both the allograft and the recipient. Our aim was to evaluate the outcomes of preemptive renal transplantation experience at our center. Since 1985, 1385 renal transplantations have been performed at our center. We retrospectively analyzed the 16/1385 recipients (11 male, 5 female) of overall mean age of 28.5 +/- 15 years who underwent preemptive procedures. The causes of end-stage renal failure were focal segmental glomerulosclerosis (n = 5), vesicular ureteral reflux (n = 4), Berger disease (n = 2), polycystic renal disease (n = 2), and others (n = 3). Ten patients were adults, the remaining six, children. The mean creatinine clearance and plasma creatinine levels of the recipients before renal transplantation were 13.5 +/- 8.5 mL/min and 6.7 +/- 2.4 mg/dL, respectively. All renal transplantations were performed from living related donors. The mean preoperative serum creatinine levels, mean glomerular filtration rate, and creatinine clearance rates of the donors were 0.8 +/- 0.1 mg/dL, 61.6 +/- 6.5 mL/min, and 112.5 12 mL/min, respectively. Two episodes of acute cellular rejection and one of humoral rejection occurred during a mean follow-up of 48.7 +/- 14 months (range = 25-76 months). The two patients who experienced graft losses due to humoral rejection or chronic rejection were retransplanted 2 and 48 months thereafter, respectively. At this time all patients are alive with good renal function. In conclusion, our single-center results are promising for preemptive renal transplantation as the optimal, least-expensive mode of treatment for end-stage renal disease.
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Affiliation(s)
- M Haberal
- Department of General Surgery, Başkent University Faculty of Medicine, Ankara, Turkey.
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12
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[Waiting lists for kidney transplantation: another reason for early nephrological care of chronic-kidney disease patients]. Nephrol Ther 2008; 4:153-4. [PMID: 18329352 DOI: 10.1016/j.nephro.2007.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 12/21/2007] [Indexed: 11/22/2022]
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