Preemptive kidney transplant

Preemptive kidney transplant

Mikel Prieto, M.D., discusses preemptive kidney transplant.

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A preemptive kidney transplant is when you receive a kidney transplant before your kidney function deteriorates to the point of needing dialysis to replace the normal filtering function of the kidneys.

Currently, most kidney transplants are performed on people who are on dialysis because their kidneys are no longer able to adequately clean impurities from the blood.

Preemptive kidney transplant is considered the preferred treatment for end-stage kidney disease, but only about 20% of kidney transplants are performed preemptively in the U.S.

Several factors have been linked to the lower than expected rate of preemptive kidney transplants, such as:

  • Shortage of donor kidneys
  • Lack of access to transplant centers
  • Low rates of physician referrals for the procedure among candidates of lower socioeconomic status
  • Lack of physician awareness of current guidelines

Why it's done

The benefits of preemptive kidney transplant before dialysis for people with end-stage kidney disease include:

  • Lower risk of rejection of the donor kidney
  • Improved survival rates
  • Improved quality of life
  • Lower treatment costs
  • Avoidance of dialysis and its related dietary restrictions and health complications

These benefits of preemptive kidney transplant are especially significant among children and adolescents with end-stage kidney disease.

Risks of preemptive kidney transplant include early exposure to the risks associated with surgery and potentially wasting native kidney function.

What you can expect

If your doctor recommends a preemptive kidney transplant, you will be referred to a transplant center for evaluation. You're also free to select a transplant center on your own or choose a center from your insurance company's list of preferred providers.

At the transplant center, your transplant team will conduct several tests to determine if a preemptive kidney transplant is appropriate for you. Your team will consider a variety of factors, including:

  • Level of kidney function
  • Overall health
  • Any chronic medical conditions that might affect the success of transplant
  • Availability of donor kidney
  • Ability to follow medical instructions and take anti-rejection medications for the rest of your life

If you are approved for a preemptive kidney transplant and a living-donor kidney is available, the living-donor kidney transplant procedure will be scheduled. If a living-donor kidney is not available, you will be placed on a waiting list for a deceased-donor kidney transplant.

Feb. 25, 2020
  1. Jay CL, et al. Reassessing preemptive kidney transplantation in the United States: Are we making progress? Transplantation. 2016;100:1120.
  2. Grams ME, et al. Trends in the timing of pre-emptive kidney transplantation. Journal of the American Society of Nephrology. 2011;22:1615.
  3. OPTN Minority Affairs Committee. Education guidance on patient referral to kidney transplantation. Organ Procurement and Transplantation Network. https://optn.transplant.hrsa.gov/resources/guidance/educational-guidance-on-patient-referral-to-kidney-transplantation/. Accessed Jan. 20, 2020.
  4. Rees L, et al. Overview of renal replacement therapy (RRT) for children with chronic kidney disease. http://www.uptodate.com/home. Accessed March 15, 2016.
  5. Brennan DC, et al. Dialysis issues prior to and after kidney transplantation. https://www.uptodate.com/contents/search. Accessed Jan. 20, 2020.

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