" Pre-emptive" transplant

[Des]

Okaral , (or anybody else )

Please help me find some info on the net about the positives/negatives of having a pre-emptive transplant.

I am still unsure if I should wait for my kidneys to completely fail before I have a transplant... but everyone advises me to have the transplant done before I start dialysis.

I just need to find some "reading" about stats of the outcome or mortality rate.

Thanks in advance

[rose1999]

I'm not Karol and she will do a much better job of finding information but here's a quick list I found on a web search which may help.

Potential advantages of pre-emptive renal transplantation
    The complications of dialysis and its initiation
    (vascular access and CAPD tube insertion) are avoided.
    More economic utilisation of resources
    Expansion of transplant waiting list population
    Better graft survival; 72 vs 60% at 5 years. [3]
Potential Disadvantages
    The risks of transplantation
    Waiting for prioritisation for transplantation will mean that most pre-emptive
    recipients will probably only receive favourable matches (which may be
    an advantage)
    Shortage of kidneys
    Potential risk of non-compliance

The whole article is on http://www.swtransplant.com/pdf/Pre-emptive%20renal%20transplantation.pdf

[Des]

Thanks,

I do have a live donor ..... I am scared that she will change her mind or something if I wait too long...

But keep the info coming....

[kellyt]

I received a non-related, living, pre-emptive transplant on Nov. 5th from my sis-in-law.  My Creatinine at the time of admission was 5.1 and my GFR had been at 7 for months prior.  My surgeon said that "pre-emptive" is what is best.  That is the "goal", but is not always acheived.  Had I not received the transplant I would have probably started dialysis with 1-2 months.  I figured I would have to do dialysis in the hospital the night before surgery, but my doctor said "No".  I feel extremely fortunate and so far I'm doing great.

I don't know if you have to be at a certain GFR before they will perform the transplant, but that is something you need to discuss with your doctor and transplant clinic.  Has your donor gone through all the testing yet?  That can take 1-3 months to complete depending.

Good Luck.

[okarol]

Pre-emptive kidney transplantation: the attractive alternative

A Asderakis, T Augustine, P Dyer, C Short, B Campbell, N Parrott and R Johnson
Renal Transplant Unit, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; Corresponding author

Background: Dialysis can be life-saving for patients with end-stage renal failure. However, not only is it associated with significant morbidity and a greater mortality than transplantation, but it is also expensive. Therefore renal transplantation is generally regarded as the treatment of choice for patients in whom this form of renal replacement therapy is appropriate. Transplantation usually takes place after a variable period of dialytic therapy, but pre-emptive kidney transplantation (PKT) has established itself as an attractive alternative. Materials and methods: 1463 consecutive first kidney transplants performed between January 1980 and December 1995 in a single centre were analysed. The 161 patients (11%) transplanted without prior dialysis were compared with the 1302 patients who had been dialysed prior to being transplanted. The pre-emptive group did not differ from the dialysis group in respect of donor age, donor and recipient gender, HLA mismatch, or cold ischaemic time, although there were more live donor transplants within the pre-emptive group. Results: Delayed graft function occurred more frequently in the dialysis group (25% vs 16%) but more patients experienced an acute rejection episode in the pre-emptive group (67 vs 55%). The actuarial graft survival in the pre-emptive group at 1, 5, and 10 years (84, 76 and 67%) was significantly higher than the respective values in the dialysis group (83, 69, and 56%). Within the live donor recipient cohort the survival advantage for the pre-emptive group was even more striking. Conclusion: Pre-emptive kidney transplantation not only avoids the risks, cost, and inconvenience of dialysis, but is also associated with better graft survival than transplantation after a period of dialysis, particularly within the live donor cohort. Key words: dialysis; pre-emptive; rejection; survival; kidney

http://ndt.oxfordjournals.org/cgi/content/abstract/13/7/1799

[okarol]

Potential kidney donors (for pre-emptive transplant). Some people may want to consider having a kidney transplant when they reach ESRD rather than having to go on dialysis. This is called a pre-emptive transplant. Obviously, this requires having a suitable and pre-qualified donor lined up. As both the patient's pre-evaluation as a potential kidney transplant recipient, and the donor's pre-evaluation as a potential kidney donor can take some time (weeks or months in some cases), this is best performed well-ahead of time (ie. the year leading up to anticipated ESRD). There can be many medical or psychological/social reasons that a potential kidney donor is rejected, and, unfortunately, it's not unheard of for a qualified kidney donor to back out of it very late in the process. Or sometimes, an illness will make it impossible to get the transplant at the time it's needed. For that reason, many nephrologists will suggest that you also choose a method of dialysis just in case it's needed (given the lead time that is required for the access surgery). Therefore, even a patient with a donor all pre-qualified for an expected pre-emptive transplant might still have fistula surgery performed, or a PD catheter inserted.

http://www.igan.ca/id78.html

[kellyt]

Good point.  I had my fistula placed in Oct. 2007 and my doctor really thought I'd start dialysis by March 2008.  Fortunately we were able to hold off.  Be prepaired for dialysis, even if you have a donor, or donors, lined up.

[Des]

Thanks Kelly, Rose and okarol....

This is exactly the type of info I needed!!!

I knew I could count on my IHD team to get me some answers.

[Wallyz]

My Dad had a preemtive SKP transplant in 1995, and is still doing well.

[vandie]

I had a pre-emptive transplant on 8/4/07 from a cadaver donor.  It was a perfect antigen match, otherwise I would not have been so fortunate. 
Any time you do not have to do dialysis is so important.  We see what is does to our friends here on IHD and know that if we can keep away from it, we are much better for it.
I have had a few medication adjustments but otherwise, no problems with the kidney. 

[Des]

Thanks

It is good to see that it has mostly a good outcome.

[openboat]

I had a transplant from a living related donor at the end of March when my creatinine was at 5.0, gfr around 12.  I guess you could call it preemptive, I spent lots of time worrying about whether it was the right option, the right time, right protocol, etc.

As soon as it was done the worries were gone - I was very happy that I had gone through with it.  One day after surgery I felt better than I had in years, PKD had progressed so slowly that I didn't realize how much of an impact it was having.  I'd say if you have the donor, surgeon and insurance coverage lined up, go for it!   

[swell]

I too had a pre-emtive transplant in April 2009 from my husband. At the time of transplant my creatinine was 7.0 and my gfr was 5. I had already been to a surgeon to consult about a PD access.
My neprrologist, my transplant surgeon and just about everyone else on the transplant team said that this was the best way to go - to avoid dialysis if at all possible.
I am very happy about the decision!