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Pre‐emptive renal transplantation from living donors in Australia: Effect on allograft and patient survival
Author(s) -
MILTON CAROLINE A,
RUSS GRAEME R,
MCDONALD STEPHEN P
Publication year - 2008
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2008.01011.x
Subject(s) - medicine , transplantation , hazard ratio , dialysis , kidney transplantation , surgery , multivariate analysis , retrospective cohort study , confidence interval
SUMMARY: Aim: Pre‐emptive renal transplantation has become the preferred first‐line therapy for patients with end‐stage kidney failure. This study examines the outcome of allograft and patient survival in pre‐emptive transplantation compared with non‐pre‐emptive transplantation from living donors in Australia and New Zealand. Methods: We have performed a retrospective study using the Australian and New Zealand Dialysis and Transplantation Registry. Allograft and patient survival were compared at 1, 5 and 10 years in pre‐emptive transplantation and non‐pre‐emptive transplantation following a living donor transplant. Results: Allograft survival at 1, 5 and 10 years post pre‐emptive transplantation was better than post non‐pre‐emptive transplantation (multivariate hazard ratio (HR) 0.80 [95% confidence interval 0.64–0.99], P = 0.036). Pre‐emptive transplantation was associated with a significant patient survival advantage over non‐pre‐emptive transplantation when analysed from the time of transplantation and adjusted for age and gender (multivariate HR 0.46 [0.27–0.80], P = 0.006). Patient survival for pre‐emptive transplantation and non‐pre‐emptive transplantation was 97% [0.95–0.98] and 93% [0.91–0.94] at 5 years and 93% [0.88–0.96] and 84% [0.82–0.87] at 10 years post transplant respectively. There was no difference in the overall rejection rate between pre‐emptive transplantation and non‐pre‐emptive transplantation. Vascular rejection was less common in pre‐emptive transplantation (HR 0.70 [0.50–0.98], P = 0.04). Conclusion: Pre‐emptive transplantation from a living donor is associated with both better allograft and patient survival compared with transplantation after a period of dialysis. Pre‐emptive transplantation should be the preferred modality of renal replacement therapy in patients who have a living donor.