Preemptive kidney transplantation: experience in two centers

Area of Science:

• Nephrology
• Transplantation Immunology
• Renal Replacement Therapy

Background:

• End-stage renal disease (ESRD) is a leading cause of mortality, with kidney transplantation significantly improving survival and quality of life compared to long-term dialysis.
• Long-term dialysis is associated with poorer patient outcomes, even following subsequent kidney transplantations.

Purpose of the Study:

• To evaluate the benefits of preemptive kidney transplantation (PKT) versus kidney transplants from living donors (LDT) and deceased donors (DDT) in patients undergoing renal replacement therapy.

Main Methods:

• A retrospective study involving 80 patients across three groups: PKT, LDT, and DDT, conducted at two transplantation centers.
• Evaluation of serum creatinine, delayed graft function (DGF), subclinical rejection, and interstitial fibrosis/tubular atrophy (IF/TA) at six months post-transplantation.

Main Results:

• Serum creatinine levels at six months were lower in living donor groups (PKT and LDT) compared to the deceased donor group (DDT).
• Delayed graft function (DGF) rates were highest in DDT (44%), significantly lower in LDT (11.5%), and absent in PKT (0%).
• Subclinical rejection and interstitial fibrosis/tubular atrophy (IF/TA) were significantly lower in PKT and LDT compared to DDT.

Conclusions:

• Preemptive kidney transplantation demonstrates superior outcomes, including lower serum creatinine, absence of DGF, and reduced subclinical rejection and chronic allograft nephropathy at six months.
• These findings highlight the advantages of PKT in improving early graft function and health in ESRD patients.