Background: Preemptive kidney transplantation (PKT) is increasingly acknowledged. We wanted to investigate the results of an active PKT policy in an unselected end-stage renal disease population with high prevalence of PKT.
Methods: From 1989 to 2007, 3400 first kidney transplantations were performed in which 809 were PKTs (24%). PKT patients were 7.4 years younger (P<0.001), had more live donors (LD; 64% vs. 35%, P<0.001), and fewer were panel reactive human leukocyte antigen antibody positive (2% vs. 6%, P<0.001).
Results: In the Cox regression analyses of patient mortality, uncensored and death-censored graft failures, all potential risk factors tested were statistically significant, except for recipient sex (i.e., recipient and donor age, PKT, deceased donor [DD], diabetes nephropathy, human leukocyte antigen-DR mismatch, and panel reactive antibody positivity). For patient mortality, PKT and DD had a hazard ratio (HR) of 0.75 (P=0.001) and 1.38 (P<0.001), respectively. The results were similar for uncensored and death-censored graft failures. Risk analyses were also performed separately for DD and LD cohorts. The results were comparable, except that PKT was not a significant risk factor in the LD cohort (HR=0.82, P=0.12 for mortality and HR=0.83, P=0.051 for uncensored graft failure). However, in DD recipients, patient mortality (HR=0.70, P=0.004) and uncensored graft failure (HR=0.68, P<0.001) were significantly reduced with PKT.
Conclusion: PKT reduced the risk of patient mortality and uncensored graft failure in DD recipients. Our study confirms the advantages of PKT in an unselected end-stage renal disease population with a high prevalence of PKT.