Faculty Collaboration Database

Reassessing Preemptive Kidney Transplantation in the United States: Are We Making Progress? Transplantation 2016 May;100(5):1120-7

Date

10/20/2015

Pubmed ID

26479285

Pubmed Central ID

PMC4989865

DOI

10.1097/TP.0000000000000944

Scopus ID

2-s2.0-84945219515 (requires institutional sign-in at Scopus site)   71 Citations

Abstract

BACKGROUND: Preemptive kidney transplantation (preKT) is associated with higher patient survival, improved quality of life, and lower costs. However, only a minority of patients receives preKT. The aim of this study was to examine changes over the past decade in rates of preKT, focusing on living donor kidney transplantation (LDKT) and specifically recipients who underwent kidney transplantation within 1 year of initiating dialysis.

METHODS: Using United Network of Organ Sharing data, we examined retrospectively all kidney transplant candidates (n = 369 103) and recipients (n = 141 254) from 2003 to 2012 in the United States focusing on LDKT (n = 47 108). Predictors of preKT were examined, and patient and graft survival were compared for preKT, pretransplant dialysis less than 1 year, and pretransplant dialysis recipients of 1 year or longer.

RESULTS: PreKT occurred in only 17% of recipients overall and 31% of LDKT recipients. Medicare patients (odds ratio [OR], 0.29; 95% confidence interval [95% CI], 0.28-0.31), diabetics (OR, 0.75; 95% CI, 0.69-0.80), and minorities (Hispanics OR, 0.62; 95% CI, 0.57-0.68 and African Americans OR, 0.58; 95% CI, 0.53-0.63) were less likely to receive preKT. Dialysis recipients for less than 1 year comprised 30% of nonpreemptive LDKT. Dialysis recipients of less than 1 year had similar patient survival to preKT (5 years: preKT, 94%; dialysis < 1 year, 94%; dialysis ≥ 1 year, 89%; P < 0.01), but decreased death-censored graft survival (5 years: preKT, 93%; dialysis < 1 year, 89%; and dialysis ≥ 1 year, 89%; P < 0.01).

CONCLUSIONS: PreKT remains an unrealized goal for the majority of recipients. Medicare patients, diabetics, and minorities are less likely to receive preKT. Almost one third of nonpreemptive LDKT recipients were dialyzed for less than 1 year, highlighting an important target for improvement.

Author List

Jay CL, Dean PG, Helmick RA, Stegall MD

Author

Ryan Helmick MD Associate Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Diabetes Complications
Female
Graft Survival
Humans
Kidney Failure, Chronic
Kidney Transplantation
Living Donors
Male
Medicare
Middle Aged
Minority Groups
Proportional Hazards Models
Quality of Life
Renal Dialysis
Retrospective Studies
Tissue and Organ Procurement
Treatment Outcome
United States
Young Adult