Previous studies have shown that pre-emptive transplantation of kidneys from living donors is associated with longer graft survival than those who have initiated dialysis prior to transplantation. However, the outcomes for recipients of deceased donors have not been widely studied yet the majority of kidneys transplanted in the United States are from deceased donors. The availability of donors varies largely among different regions: while some regions see many years of waiting time, others may have patients receiving kidneys before dialysis.

Methods: We assessed the impact of pre-emptive transplant in the recipient population of deceased kidney donors. Patients who were referred for kidney transplant evaluation were drawn from a database of a large commercial health plan between January 2009 and March 2015. Outcomes were followed through April 30, 2015. Multivariate proportional hazard models were used to estimate time to graft failure or patient death. Outcome analysis was adjusted by age, gender, patient's comorbid conditions via Charlson Comorbidity Index, transplant primary diagnosis, UNOS regions, and socio-economic status.

Results: A total of 918 patients who underwent deceased donor kidney transplantation were included in the study, and 25.5% of recipients received no dialysis prior to transplant, 26.7% received dialysis and an early transplant (within one year of dialysis initiation) and 47.8% had a late transplant (after one year of dialysis).

Table 1. Adjusted Hazard Ratios of Graft Failure in Kidney Deceased Donor Transplant Recipients

Table 2. Adjusted Hazard Ratios of Patient Death in Kidney Deceased Donor Transplant Recipients

Conclusions: We found patients transplanted pre-emptively had no difference in both graft and patient survival compared with patients transplanted within or after one year of dialysis.

CITATION INFORMATION: Tao J, Wu C, Bannister W, Schnitzler M, Bonagura A, Laihinen B, Irwin F. Does Pre-Emptive Transplantation Improve Survival Compared to Transplantation After Dialysis Among Deceased Donor Kidney Recipients? Am J Transplant. 2016;16 (suppl 3).

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