Preemptive kidney transplant: indication, outcome and complications

Dialysis and kidney transplantation are the only available management approaches for these patients. Estimates show that the survival rates and quality of life are significantly higher for patients that receive kidney transplantation than others with dialysis. In addition, the effectiveness of preemptive kidney transplantation was well-evidenced in the literature. It had been further demonstrated that performing preemptive kidney transplantation significantly reduces the complications of renal transplantation and dialysis and was incredibly cost-effective when compared to dialysis. Furthermore, evidence regarding its effectiveness was well-established among studies in the literature as a safe primary management approach for patients suffering from end-stage kidney disease. This literature review discussed preemptive kidney transplantation's indications, outcomes and complications. Our findings indicated the efficacy of the approach for patients suffering from end-stage kidney disease. However, the appropriate selection of the patients was a critical issue. Besides, serious efforts should be exerted to prepare the patient perioperatively. Nevertheless, kidney functions were reported to increase following preemptive kidney transplantation. Graft rejection and delayed graft functions were also reported to follow preemptive kidney transplantation. However, the estimated rates are lower than those for patients having transplantation following the start of dialysis. We encourage further relevant investigations to further elaborate on the long-term findings, prognosis, and complications.

Dialysis Access and Preemptive Kidney Transplantation

Sustainable vascular or peritoneal access for dialysis is very important for patients undergoing dialysis therapy, and access trouble is occasionally involved with unexpected occurrence of complications. Once access trouble occurs, dialysis therapy might be discontinued and be followed by a life-threatening state of patients with end-stage kidney disease. Bacterial infection, massive bleeding, and thrombosis in patients undergoing hemodialysis and acute infectious peritonitis and chronic encapsulating peritoneal sclerosis in patients undergoing peritoneal dialysis are important clinical issues. Preemptive kidney transplantation prior to dialysis has several advantages over transplantation after exposure to dialysis therapy. One of the notable advantages is the lack of necessity of dialysis access, which avoids access operations before transplantation. However, some transplant recipients may need short-term dialysis therapy due to the unexpected progression of chronic renal dysfunction. Dialysis access is required in a short preoperative period for preconditioning. The selection of renal replacement therapy without complications in a short-term dialysis before transplant surgery is important for the success of kidney transplantation. Appropriate preparation of short-term dialysis therapy and access is a key to success of preemptive kidney transplantation.

Supplemented Low-Protein Diet May Delay the Need for Preemptive Kidney Transplantation: A Nationwide Population-Based Cohort Study

Background: Although several studies suggest the benefit of a low-protein diet supplemented with amino acids and keto acids (sLPD) in delaying the initiation of hemodialysis, evidence on whether these nutritional approaches could delay the timing of preemptive transplantation is lacking. Methods: Retrospective nationwide cohort study, from Taiwan’s National Health Insurance Research Database. Patients having undergone a first preemptive kidney transplantation between 2001 and 2017 were identified and divided into two groups according to the presence of sLPD treatment or not. The primary outcome was the time between the diagnosis of advanced CKD and transplantation. Secondary outcomes were post-transplantation adverse events. Results: A total of 245 patients who received their first preemptive kidney transplantation were identified from the nationwide database; 63 of them had been on an sLPD prior to transplantation (sLPD group). The duration between the day of advanced CKD diagnosis and the day of transplantation was significantly longer in the sLPD group compared with the non-sLPD group (median duration: 345 vs. 220 days, p = 0.001). The risk of post-transplantation adverse events did not differ between the two groups. Conclusions: Within the limits of its observational, retrospective design, this is the first study to suggest that nutritional management with sLPDs can safely delay the timing of preemptive kidney transplantation.