A Single-Center, Retrospective Comparison of Non-Pre-emptive with Pre-emptive Renal Transplantations.

Introduction: End-stage renal disease (ESRD) requires renal replacement therapy, either through pre-emptive transplantation (PET) or non-pre-emptive transplantation (non-PET). PET is associated with improved patient and allograft survival compared to non-PET; however, only 2.5% of patients in the United States undergo PET. The authors of this study report on mortality and allograft rejection rates in patients undergoing PET versus non-PET.

Methods: This single-center, retrospective study compared posttransplant complications between PET and non-PET in adults with ESRD. De-identified electronic health record data from 2017 to 2022 were analyzed. Odds ratios (ORs) for one-year post-transplant mortality and allograft rejection were calculated using unadjusted multivariate logistic regression (Model 1), adjusted for age and sex (Model 2), and further adjusted for comorbidities (Model 3).

Results: A total of 787 patients with ESRD underwent kidney transplantation: 14% underwent non-PET and 86% underwent PET. Compared to PET, the ORs for one-year post-transplant mortality with non-PET were:Model 1: OR 1.76 (95% CI, 0.64-4.85; p = 0.27)Model 2: OR 2.02 (95% CI, 0.71-5.71; p = 0.19)Model 3: OR 1.86 (95% CI, 0.64-5.39; p = 0.24)For one-year allograft rejection, the ORs for non-PET versus PET were:Model 1: OR 1.63 (95% CI, 0.85-3.10; p = 0.13)Model 2: OR 1.61 (95% CI, 0.84-3.06; p = 0.15)Model 3: OR 1.60 (95% CI, 0.82-3.10; p = 0.16).

Conclusions: This single-center study found no statistically significant differences in one-year mortality or allograft rejection between patients undergoing PET and non-PET.