Review article
The Importance of Pre-Emptive Kidney Transplantation (PKT)
Lidija Orlić
Abstract
Pre-emptive kidney transplantation (PKT) is defined as a kidney transplant performed before starting dialysis. It has several advantages for patients. Primarily, this method avoids complications related to dialysis. PKT also has a positive financial aspect, it is significantly cheaper than dialysis. The incidence of PKT is different: in the USA it is from 2.5% to 9.3% of the total number of kidney transplants, and in Spain 5%. In some transplant centers, the percentage of PKT is significantly higher. All patients who are candidates for kidney transplantation are also candidates for PKT. In general, PKT is recommended when the glomerular filtration rate (GF) falls below 15 ml/min. KDIGO (Kidney Disease: Improving Global Outcomes) guidelines recommend PKT when the GF is less than 10 ml/min, or earlier if symptoms are present. The optimal time for PKT has not yet been defined. During the last decades, numerous studies on PKT have been published from different countries and transplant centers that analyzed the outcomes of patient survival, transplants, and cardiovascular events. Sometimes the results were contradictory. Two meta-analyses published in the last year have shown the benefits of PKT especially in terms of patient and graft survival. The advantage of PKT from a living donor has also been proven. Older patients have advantages from PKT also and even in transplants from older donors, compared to dialysis. PKT is the method of choice in the treatment of children with end-stage renal failure. The second PKT also has advantages. At the Clinical Hospital Center Rijeka, since 2014, we have been performing PKT from a deceased donor, which makes up about 10% of the total number of kidney transplantations. One of the main reasons for not performing PKT is the lack of a potential living kidney donor and late referral of the patient to the transplant center.
Keywords
pre-emptive kidney transplantation; dialysis; donor; transplant center
Hrčak ID:
315863
URI
Publication date:
9.4.2024.
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