Pre-emptive Transplants -- how often do they really happen?

[Deanne]

For people who have plenty of warning that their kidneys are failing and opt to try for a pre-emptive transplant, how often do they really get one before needing to go on dialysis? Is there a slim chance of it happening, 50/50 odds of getting a transplant in time, or even better than 50/50?

I'm assuming I'll need a cadaveric donor. It'd be nice if one of my siblings is able to donate, but I'm not counting on it. They each have their own "stuff" to deal with in addition to living a couple thousand miles away from me.

[Wenchie58]

I got listed fairly early and was on the list 15 months before receiving a cadaveric kidney (bless my donor family).  I dodged the dialysis bullet and for that I am eternally thankful!
 

[KT0930]

My second transplant was supposed to be pre-emptive (Dad was the donor). He got most of the testing done in Oct 2001, and we had the surgery date set for January 11, 2002. Unfortunately I got very sick in mid December (pharmacy gave me anti seizure meds instead of stuff for high blood pressure) and I started dialysis the week of Christmas. The doc (surgeon)wanted to wait a little while before doing the surgery to make sure I was really over it, then he went on vacation for the month of Feb. I had the transplant March 9.

So to answer your question, I don't know how often they actually happen, but mine was scheduled and set to go until I got sick, so I guess they really do happen at least occasionally!

[kellyt]

I got my fistula placed in Oct 2007 and began the testing process to get on the list that same month.  I was listed in Feb 2008 and received a living, non-related transplant in Nov. 2008.  My doctor had been holding a chair for me at the downtown, nocturnal clinic since March 2008 and every month when I saw him he felt I'd be on dialysis within 2-3 months.  But I fooled him and got my kidney before ever having to go!

[Deanne]

It's good to see that there's hope. I see my neph this afternoon to find out if I need to start the transplant evaluation process.

[Deanne]

I found this that's a bit discouraging (http://www.medscape.com/viewarticle/462610_2):

Preemptive renal transplantation occurred in 25% of adult recipients of allografts from living donors in the United States in the latter part of the twentieth century.[2,3] The lower rate of PRT of cadaveric renal allografts into adult recipients, approaching 10%, is likely attributable to the prolonged waiting times of transplant candidates on the cadaveric list, during which persons become dialysis-dependent. In comparison, children who develop ESRD have increased PRT rates of approximately 34% from living donors and 14% from cadaveric donors.[4] The collection of reasons that contribute to the infrequent use of PRT among adults is undefined, but includes donor availability and perhaps an unclear understanding about the advantages of PRT among health care providers leading to delayed referrals to a nephrologist and transplant center.[5] The significance to the patient of the under utilization of PRT and the overlooked opportunities for the avoidance of dialysis-associated morbidities and improved transplant survival may be substantial.

[okarol]

Deanne, if you look at the bottom of that page you'll see that it says "American Journal of Transplantation. 2003;3(11) © 2003" - and the referenced articles are from 2001 - 2003. I can only say that things have changed a great deal over the past few years that there's good reason to hope for more pre-emptive transplants.

[Deanne]

Thanks! I was looking for a date on the article and couldn't find it.

[Romona]

I got mine in June of 2006. I was to get things ready for dialysis in August of that year.

[swell]

I got my transplant in April 2009, donated by my husband. I had already seen a surgeon for a PD access in January, but was trying to hold off on that surgery in hopes that the testing for me and my husband would be completed in time. It was (!!!) and the transplant was scheduled 4/29/09!! I was still working full time up until the day of my surgery ( still working full time now too!)
What a blessing that I was able to avoid dialysis. I am eternally grateful to God, my husband and the wonderful transplant team at Medical College of Georgia!