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Preemptive kidney transplantation: the advantage and the advantaged
Bertram L Kasiske1, Jon J Snyder, Arthur J Matas
1The United States Renal Data System Coordinating Center, Minneapolis, Minnesota 55414, USA. kasis001@umn.edu
Journal of the American Society of Nephrology : JASN
|April 19, 2002
Summary
Preemptive kidney transplantation improves patient and graft survival but is less common in minority groups and those with less education. Policy changes could increase access to this beneficial procedure.
Area of Science:
- Nephrology
- Transplantation Immunology
- Health Services Research
Background:
- Preemptive kidney transplantation (PKT) involves transplanting a kidney before the recipient requires dialysis.
- The benefits and patient populations for PKT remain incompletely understood.
- Understanding factors influencing PKT is crucial for optimizing kidney transplant outcomes.
Purpose of the Study:
- To evaluate the benefits of PKT on graft failure and patient survival.
- To identify demographic and clinical factors associated with receiving PKT.
- To explore disparities in access to PKT.
Main Methods:
- Retrospective analysis of 38,836 first kidney-only transplants (1995-1998).
- Cox proportional hazards models used to assess risks of graft failure and death.
- Logistic regression identified factors associated with PKT.
Main Results:
- PKT was associated with a reduced risk of graft failure (relative risk [RR] 0.75 for cadaveric, 0.73 for living donors).
- PKT significantly reduced the risk of death (RR 0.84 for cadaveric, 0.69 for living donors).
- PKT was less common among racial minorities, those with lower education, and Medicare recipients.
Conclusions:
- Preemptive kidney transplantation offers significant survival benefits for both patients and grafts.
- Disparities exist in PKT access, with underrepresentation of minority and less educated populations.
- Policy interventions targeting payment systems, early referral, and organ allocation could improve equitable access to PKT.