Kidney Week

Abstract: SA-PO077

Appropriateness and Outcomes of Premature Pre-emptive Renal Transplants (PPRT), i.e. Renal Transplants at GFR>/= 19mL/min

Session Information

• Transplantation: Recipient and Donor Assessment
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Shrivastava, Snehal, University Of Toledo Medical Center, Toledo, Ohio, United States

Snehal Shrivastava,

• Koizumi, Naoru, George Mason University, Arlington, Virginia, United States

Naoru Koizumi,

• Malhotra, Deepak K., The University of Toledo, Toledo, Ohio, United States

Deepak K. Malhotra,

• Ortiz, Jorge, University Of Toledo Medical Center, Toledo, Ohio, United States

Jorge Ortiz,

Background

A pre-emptive kidney transplant is the best renal replacement therapy for ESRD patients. There are no guidelines for the GFR at which pre-emptive transplantation should occur. Pre-emptive renal transplants at GFR >15 ml/min represent about nine percent of total recipient population per year.
The goal of this study is to evaluate the outcomes of PPRTs. Another objective of this study is to outline the donor, recipient, and transplant characteristics of pre-emptive renal transplants.

Methods

Retrospective analysis of the UNOS database was performed on19,207 preemptive renal transplants, including deceased donors (n=12,951) and living donors (n=6,256), between years 2010-2016. Patient survival or death-censored graft survival were compared across predetermined eGFR groups at the time of transplantation, using Kaplan-Meier curves. Relevant donor, transplant & recipient characteristics were compared using t-/Wilcoxon-Mann-Whitney & Chi-sq/Fishers exact tests. Logistic regression was used to identify factors associated with pre-emptive renal transplants. Cox regression analysis was used to identify risk factors for adverse outcomes.

Results

In PPRT with all types of donors, the rate of graft survival is lower at higher GFRs (>/=19). History of diabetes in the recipient (OR=1.176, p=0.000), high number of previous transplants (OR=1.332, p=0.000) & older age (OR=1.004, p=0.012) increase the odds of receiving pre-emptive renal transplants. High BMI (OR=0.988, p=0.000) and high levels of HLA mismatch (OR=0.965, p=0.001) are less likely to receive a preemptive transplant. Increased risk of graft failure is seen in recipients with an increased number of previous transplants (HR=1.155, p=0.029), higher KDRI (HR=1.567, p=0.009) and diabetes (HR=1.218, p=0.021).

Conclusion

PPRT is associated with worse graft outcomes across all donor and recipient characteristics studied. Installation of guidelines for GFR at which pre-emptive renal transplants should occur is warranted through further research. This is especially important as PPRTs, (transplants occurring at GFR >/=19) may represent wastage of existing renal function in recipients, earlier exposure to surgical risks for live donors and recipients, and potential early requirement of next renal transplant.