Trends in the Timing of Pre-emptive Kidney Transplantation

Trends in the Timing of Pre-emptive Kidney Transplantation
Morgan E. Grams*†, Allan B. Massie†‡, Josef Coresh*† and Dorry L. Segev†‡
+ Author Affiliations

*Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland;
†Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland;
‡Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
Correspondence:
Dr. Dorry Segev, Director of Clinical Research, Transplant Surgery, Johns Hopkins Medical Institutions, 720 Rutland Avenue, Ross 771B, Baltimore, MD 21205. Phone: 410-502-6115; Fax: 410-614-2079; E-mail: dorry@jhmi.edu
Received for publication January 6, 2011.
Accepted for publication March 21, 2011.

Abstract

Preemptive kidney transplantation is considered the best available renal replacement therapy, but no guidelines exist to direct its timing during CKD progression. We used a national cohort of 19,471 first-time preemptive kidney transplant recipients between 1995–2009 to evaluate patterns and implications of transplant timing. Mean estimated GFR (eGFR) at the time of preemptive transplant increased significantly over time, from 9.2 ml/min/1.73m2 in 1995 to 13.8 ml/min/1.73m2 in 2009 (P<0.001). Patients with eGFR≥15 ml/min/1.73m2 represented an increasing proportion of preemptive transplant recipients, from 9% in 1995 to 35% in 2009; the trend for patients with eGFR≥10 was similar (30% to 72%). We did not detect statistically significant differences in patient survival or death-censored graft survival between strata of eGFR at the time of transplant, either in the full cohort or in subgroup analyses of patients who might theoretically benefit from earlier preemptive transplantation. In summary, preemptive kidney transplantation is occurring at increasing levels of native kidney function. Earlier transplantation does not appear to associate with patient or graft survival, suggesting that earlier preemptive transplantation may subject donors and recipients to premature operative risk and waste the native kidney function of recipients.

http://jasn.asnjournals.org/content/early/2011/05/26/ASN.2011010023.abstract?papetoc