Preemptive kidney transplantation: a propensity score matched cohort study.

Area of Science:

• Nephrology
• Transplantation immunology
• Clinical outcomes research

Background:

• Preemptive kidney transplantation (PKT) is associated with improved outcomes, but the underlying reasons and post-transplant complications remain poorly understood.
• Limited research has investigated the specific impact of PKT on various post-transplant complications.

Purpose of the Study:

• To evaluate the outcomes of preemptive kidney transplantation (PKT) versus non-PKT in adult living kidney transplant recipients.
• To assess the impact of PKT on post-transplant renal function and common complications.

Main Methods:

• A retrospective analysis of adult living kidney transplant recipients between 2000 and 2014.
• Inclusion of both unmatched (n=1060) and propensity score-matched (n=186) cohorts.
• Evaluation of outcomes including estimated glomerular filtration rate (eGFR), rejection, cytomegalovirus (CMV) infection, post-transplant diabetes mellitus (PTDM), cardiovascular disease (CVD), graft failure, and malignancy.

Main Results:

• Mean eGFR at 2 weeks post-transplant was comparable between matched PKT and non-PKT groups (45.2 vs. 46.5 mL/min/1.73 m²).
• PKT did not demonstrate superiority in reducing the risk of rejection, CMV, PTDM, or malignancy.
• While graft failure and CVD risks were reduced in the unmatched PKT group, these benefits were not observed after propensity score matching.

Conclusions:

• Preemptive kidney transplantation (PKT) was not associated with improved post-transplant renal function in living kidney transplant recipients.
• PKT did not lead to a lower rate of common post-transplant complications compared to non-PKT.
• The findings suggest that the benefits of PKT may not extend to improved renal function or reduced complication rates in this patient population.