Preemptive Deceased-Donor Renal Transplant in Adults: Single-Center Experience and Outcome

Abstract

Preemptive renal transplant has been associated with better survival of both the allograft and the recipient than has conventional renal transplant. It remains unclear, however, whether preemptive transplant is optimal for renal replacement therapy. We describe our experience with preemptive renal transplant. We retrospectively analyzed 32 preemptive and 132 nonpreemptive deceased-donor renal transplants performed in our center between January 2006 and January 2008. The mean follow-up was 47.44 ± 11.92 months in the preemptive group, compared with 47.49 ± 14.87 months in the nonpreemptive group. The 1-, 3-, and 5-year patient survival rates were 93.8%, 90.6%, and 90.6% in the preemptive group, and 92.4%, 90.9%, and 87.6% in the nonpreemptive group; and the 1-, 3-, and 5-year graft survival rates were 93.8%, 93.8%, and 93.8% in the preemptive, and 89.4%, 85.6%, and 73.8% in the nonpreemptive group. None of these differences was statistically significant. Rates of acute rejection (P = .04) and delayed graft function (P = .03) were significantly lower in the preemptive group. The mean plasma creatinine levels at 1 day before transplant and at 1 and 12 months after transplant were 715.16 ± 114.92 μmol/L, 113.15 ± 29.17 μmol/L, and 94.59 ± 18.56 μmol/L in the preemptive group, and 772.62 ± 111.38 μmol/L, 118.46 ± 30.94 μmol/L, and 100.78 ± 15.03 μmol/L in the nonpreemptive group. None of these differences was statistically significant. Preemptive transplant can yield outcomes comparable to those of renal transplant after dialysis, and result in better quality of life for patients with end-stage renal disease, as well as reduced cost. Preemptive transplant is a better choice for renal replacement therapy, if possible.