Can preemptive kidney transplantation guarantee longer graft survival in living-donor kidney transplantation? Single-center study

Transplant Proc. 2010 Apr;42(3):766-74. doi: 10.1016/j.transproceed.2010.02.050.

Abstract

Introduction: The benefit of preemptive kidney transplantation (KTx) for graft survival compared with nonpreemptive KTx is controversial.

Objective: To analyze the influence of preemptive KTx on graft survival.

Patients and methods: The study included 476 of 531 patients who had undergone living-donor KTx between January 2000 and June 2007. Pediatric patients and those who had previously undergone KTx were excluded. Recipients were divided into 2 groups; group 1 included 413 patients (86.8%) who received grafts after institution of maintenance dialysis, and group 2 included 63 patients (13.2%) who underwent preemptive KTx.

Results: Donor type and HLA mismatch demonstrated significant differences between the 2 groups. Group 1 had more living donors and fewer HLA mismatches. Warm ischemia time in group 2 was significantly shorter than in group 1. The serum creatinine concentration in group 1 on postoperative day 7 was significantly higher than in group 2. Five- and 10-year graft survival in groups 1 and 2, respectively, were 95.3% and 81.3% vs 92.9% and 92.9%. Graft survival was not significant insofar as duration and method of dialysis. At our institution, independent risk factors for graft survival in living-donor KTx are primary end-stage renal disease, acute cellular rejection episodes, and recipient age.

Conclusion: We observed no benefit on graft survival in recipients of living-donor KTx insofar as whether they had undergone previous dialysis.

MeSH terms

  • Adolescent
  • Adult
  • Bacterial Infections / epidemiology
  • Child
  • Creatinine / blood
  • Female
  • Graft Rejection / epidemiology
  • Graft Survival / physiology*
  • HLA Antigens / immunology
  • Histocompatibility Testing
  • Humans
  • Kidney Failure, Chronic / physiopathology
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / immunology
  • Kidney Transplantation / physiology*
  • Living Donors*
  • Male
  • Middle Aged
  • Peritoneal Dialysis
  • Postoperative Complications / epidemiology
  • Renal Dialysis
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Virus Diseases / epidemiology

Substances

  • HLA Antigens
  • Creatinine