Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease

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Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease

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Co-author 1

Ahmed El arbagy ahmed.mohamed@med.menofia.edu.eg Menoufia university Internal medicine Mansoura Egypt -

Co-author 2

Ahmed El thakaby ahmed_hassanrma@yahoo.com National institute of urology and nephrology Nephrology unit Cairo Egypt -

Co-author 3

Heba Kasem heba.kasem@med.menofia.edu.eg Menoufia university Internal medicine Shebin El kom Egypt -

Co-author 4

Heba Kamal heba.abdallah@med.menifia.edu.eg Menoufia university Internal medicine Shebin El kom Egypt *

Co-author 5

Ahmed Mosad AHMED.Mosaad3071@med.menofia.edu.eg Menoufia university Internal medicine Shebin el kom Egypt -

Co-author 6

Ahmed Maged amaged186@yahoo.com National Institute of Urology and Nephrology, Nephrology unit Cairo Egypt -

Co-author 7

Co-author 8

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

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Co-author 15

Introduction

Pre-emptive kidney transplantation (PEKT), i.e., transplantation performed before initiation of maintenance dialysis, is considered an ideal renal replacement therapy because there is no exposure to long-term dialysis therapy. Therefore, we summarized advantages/disadvantages of PEKT to assist in deciding whether kidney transplantation should be performed pre-emptively.

Methods

a retrospective study included 152 kidney transplant recipients. These studied patients were divided into two groups: group A (Pre-emptive kidney transplantation (PEKT) and group B (non-PEKT). Records for kidney transplant patients from living donors obtained and revised for the following data : duration of dialysis before transplantation, comorbidities, pre-transplant work up and investigations, Donor data, Recipient data, operative data , Immunosuppressive treatment, follow up till time of the study {rejection, death , infection, malignancy}, last clinical and laboratory data including [s.creat and eGFR ] , determination of kidney survival during the period of the study .

Results

PEKT patients had lower all-cause mortality (31.6% of the PEKT vs 50% of the non-PEKT), and lower death-censored graft failure (10.5% of the PEKT vs13.2% of the non-PEKT). Also, percentage for the following outcomes were comparable between the two patient groups: cardiovascular disease,2.6% of the PEKT vs 3.5% of the non-PEKT; biopsy-proven acute rejection, 7.9% of the PEKT vs 16% of the non-PEKT; cytomegalovirus infection and urinary tract infection, 0% of the PEKT vs 3.5% of the non-PEKT. Mean differences in post-transplant QOL score were comparable in both groups.

Conclusion

The present study shows the potential benefits of PEKT, especially regarding patient and graft survival, and therefore PEKT is recommended for adults with end-stage kidney disease.

Kewords