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Abstract: FR-PO839

Comparison of Trends and Mortality Benefit to Preemptive Kidney Transplantation Over the Last Two Decades

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Kumar, Abhishek, Yale School of Medicine, New Haven, Connecticut, United States
  • Ten Eyck, Patrick, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
  • Kuppachi, Sarat C., The University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
Background

Pre-emptive kidney transplantation (PKT) is considered the optimal treatment option for advanced chronic kidney disease with improved patient and graft survival. We studied the trends in PKT over the last two decades -to determine whether kidney transplants are being performed at a higher eGFR as a consequence of greater push for preemptive transplant.

Methods

We analyzed adult, first time PKT alone recipients using United Network of Organ Sharing data. Baseline characteristics were compared using chi-square analysis for categorical variables and t test for continuous variables. Multivariable Cox regression was used to assess the difference in mortality.

Results

49,675 patients have received preemptive kidney transplant since 2000 in our cohort. PKT rates have been stable at about 15% to 17% of all kidney transplant. Proportion of preemptive kidney transplants from living donors have slightly reduced from 67% to 62% over the last decade. Early PKT (egfr >15ml/min) account for 25% of preemptive transplants and has remained stable over the last decade. Living donors account for 70% of these transplants with some decline in the last five years to 65%. We did not find any mortality benefit in early PKT compared to being on dialysis for < 180 days (HR of 1.12, CI 0.994-1.27, p 0.063).

Conclusion

Early preemptive kidney transplant in recipients with egfr >15ml/min is not an uncommon occurrence even among living recipients where the procedure timing can be controlled. Starting the proverbial transplant clock earlier does not confer a mortality benefit.

Distributions of eGFR at the time of transplantation in recipient of preemptive kidney transplant as illustrated by kernel density plots.