A Single-Center, Retrospective Comparison of Non-Pre-emptive with Pre-emptive Renal Transplantations

Area of Science:

• Nephrology
• Transplantation Immunology
• Public Health

Background:

• End-stage renal disease (ESRD) necessitates renal replacement therapy, with kidney transplantation being a primary option.
• Pre-emptive transplantation (PET) involves transplanting a kidney before the initiation of dialysis, while non-pre-emptive transplantation (non-PET) occurs after dialysis initiation.
• While PET is generally associated with improved patient and allograft survival, its utilization remains low in the United States.

Purpose of the Study:

• To compare one-year post-transplant mortality and allograft rejection rates between patients undergoing PET and non-PET.
• To evaluate the impact of pre-emptive versus non-pre-emptive kidney transplantation on patient outcomes.

Main Methods:

• A retrospective, single-center study analyzed de-identified electronic health records of 787 adult ESRD patients who underwent kidney transplantation between 2017 and 2022.
• Odds ratios (ORs) for one-year post-transplant mortality and allograft rejection were calculated using multivariate logistic regression, with adjustments for age, sex, and comorbidities.
• The study compared outcomes between the PET group (86% of patients) and the non-PET group (14% of patients).

Main Results:

• No statistically significant differences were observed in one-year post-transplant mortality between the non-PET and PET groups across all models (Model 1: OR 1.76, p=0.27; Model 2: OR 2.02, p=0.19; Model 3: OR 1.86, p=0.24).
• Similarly, no statistically significant differences were found in one-year allograft rejection rates between the non-PET and PET groups (Model 1: OR 1.63, p=0.13; Model 2: OR 1.61, p=0.15; Model 3: OR 1.60, p=0.16).

Conclusions:

• This study did not find statistically significant differences in one-year mortality or allograft rejection between pre-emptive and non-pre-emptive kidney transplantation in adult ESRD patients.
• Further research with larger sample sizes and longer follow-up periods may be warranted to explore potential subtle differences in outcomes.