Early Pre-Emptive Kidney Transplant Does Not Offer Any Mortality Benefits: A Study of Trends in Pre-Emptive Kidney Transplantation Over the Last Two Decades

Background

Pre-emptive kidney transplantation is considered the optimal treatment for end stage kidney disease (ESKD). The aim of the study is to evaluate current state of pre-emptive kidney transplants in the United States with focus on mortality benefit with early pre-emptive transplants.

Methods

Using the United Network of Organ Sharing database, we explored trends in pre-emptive kidney transplantation in first time adult recipients. We created four groups (estimated glomerular filtration rate [eGFR] < 10 mL/min/1.73 m², 10 to < 15 mL/min/1.73 m², 15 to < 20 mL/min/1.73 m², and ≥ 20 mL/min/1.73 m²) based on the eGFR at the time of transplant. Multivariable Cox regression was used to assess the difference in mortality and cumulative incidence competing risk (CICR) method was used to compare risk of ESKD among the groups.

Results

Pre-emptive kidney transplant remain at roughly 18% of total kidney transplant (33% were from deceased donors and 67% from living donors). White patients with a higher level of education and with private insurance were most likely to receive pre-emptive kidney transplant. No difference in mortality was found in the four eGFR groups. In a subgroup analysis looking only at recipients of pre-emptive kidney transplant from living donors, no mortality difference was again noted among the four groups.

Conclusions

Pre-emptive kidney transplants continue to favor a select population and remain at low numbers (9% of total deceased donor kidney transplants and 33% of living donor kidney transplants [LDKTs]). Early pre-emptive living donor kidney transplant did not confer a mortality benefit compared to transplantation when eGFR was < 15 mL/min/1.73 m².