Aim: Pre-emptive renal transplantation has become the preferred first-line therapy for patients with end-stage kidney failure. This study examines the outcome of allograft and patient survival in pre-emptive transplantation compared with non-pre-emptive transplantation from living donors in Australia and New Zealand.
Methods: We have performed a retrospective study using the Australian and New Zealand Dialysis and Transplantation Registry. Allograft and patient survival were compared at 1, 5 and 10 years in pre-emptive transplantation and non-pre-emptive transplantation following a living donor transplant.
Results: Allograft survival at 1, 5 and 10 years post pre-emptive transplantation was better than post non-pre-emptive transplantation (multivariate hazard ratio (HR) 0.80 [95% confidence interval 0.64-0.99], P = 0.036). Pre-emptive transplantation was associated with a significant patient survival advantage over non-pre-emptive transplantation when analysed from the time of transplantation and adjusted for age and gender (multivariate HR 0.46 [0.27-0.80], P = 0.006). Patient survival for pre-emptive transplantation and non-pre-emptive transplantation was 97% [0.95-0.98] and 93% [0.91-0.94] at 5 years and 93% [0.88-0.96] and 84% [0.82-0.87] at 10 years post transplant respectively. There was no difference in the overall rejection rate between pre-emptive transplantation and non-pre-emptive transplantation. Vascular rejection was less common in pre-emptive transplantation (HR 0.70 [0.50-0.98], P = 0.04).
Conclusion: Pre-emptive transplantation from a living donor is associated with both better allograft and patient survival compared with transplantation after a period of dialysis. Pre-emptive transplantation should be the preferred modality of renal replacement therapy in patients who have a living donor.