Pre-emptive live-donor kidney transplantation: Clinical course and outcome

Abstract

Background/Aims: Renal transplantation (RTX) is a definitive therapeutic modality in end-stage renal disease (ESRD). Most ESRD patients in Egypt experience dialysis prior to RTX. Dialysis is not only associated with morbidity, but it is also expensive. In developing countries, pre-emptive transplantation (PTX) may be a cost-effective option, offering an additional benefit to conventional RTx.

Materials: Between March 1976 and March 2001, 1279 first live-related transplants were performed in our center. The 82 (6.4%) patients transplanted without prior dialysis were compared with 1197 patients who had been dialyzed prior to transplantation.

Results: Median follow-up was 65.3 months in the PTX group and 62.1 months in the dialysis-dependent control group. The dialysis-dependent group received more blood transfusions (65% vs 30%), and had hepatitis B antigen positivity in 0.9%, while none of the PTX group was HBsAg positive. The actuarial graft and patient survival at 5 years was comparable in both groups (p=0.2, 0.8 respectively). The incidence of acute and chronic rejection was not different between the two groups. Mortality rate was not different between both groups (20.7% vs 19.2% respectively); however, the incidence of cardiovascular causes of death with a functioning graft in the PTX group was significantly higher (37% vs 17%), while chronic liver disease leading to death was significantly higher in the control group (8% vs 0%).

Conclusion: PTX offers comparable patient and graft survival to conventional RTX. It eliminates the complications and inconvenience of dialysis. PTX is more cost-effective; therefore, it should be encouraged in a developing country.