Lack of Utilization of Pre-Emptive Transplantation in Those With Living Donor Kidney Transplants

A. Sakhuja,¹ A. Naik,¹ R. Eikstadt,² P. Shrivastava,¹ D. Cibrik,¹ M. Samaniego.¹

¹Division of Nephrology, University of Michigan, Ann Arbor, MI
²KECC, University of Michigan, Ann Arbor, MI.

Meeting: 2015 American Transplant Congress

Abstract number: 462

Keywords: Donors, Kidney, Kidney transplantation, unrelated

Session Information

Session Name: Concurrent Session: Kidney: Living Donor Issues III

Session Type: Concurrent Session

Date: Tuesday, May 5, 2015

Session Time: 4:00pm-5:30pm

Presentation Time: 4:12pm-4:24pm

Location: Terrace I-III

Introduction: Time spent on dialysis before kidney transplantation (KTx) has been associated with worse outcomes. Pre-emptive transplants are not always possible due shortage of deceased donor kidneys, however, wait-times should be minimal for those with living donors. We assessed pre-transplant time spent on dialysis and its trends in those with living donor kidney transplants (LDKTx).

Methods: We used data from UNOS/OPTN database for patients ≥18 yr old who received a LDKTx between 2000-2012. Those transplanted through paired exchange, domino, non-directed donation or list-exchange were excluded. Patients were divided into 3 groups based on their pre-Tx dialysis status as per transplant recipient registration data –pre-emptive, on dialysis < 1 year, on dialysis ≥1 year. Linear regression was used to assess trends over time.

Results: Of the 68,128 LDKTx recipients, 63.7% had a living related donor (LRD). Overall, 32.6% of LDKTx recipients were pre-emptive, 29.3% were on dialysis <1 yr and 38.1% were on dialysis for ≥1 yr. Among LDKTx recipients with LRD – 31.4% were pre-emptive, 29.9% of recipients were on dialysis <1 year, and 38.7% were on dialysis ≥1 yr. Among recipients with 0% cPRA at the time of LDKTx – 36.0% were pre-emptive, 27.3% were on dialysis for <1 yr and 36.7% were on dialysis for ≥1 year. Overall among those with LDKTx, pre-emptive transplantation has increased over time (slope 0.84, p<0.001), and there has been a decline in recipients on pre-transplant dialysis for <1yr (-0.53, p<0.001) and ≥1 yr (-0.30, p=0.001) (Fig 1) with similar trends in those with LRD KTx recipients, however, much of the improvement in trends seems to have been in the earlier years.

Conclusions: About 2/3^rd of LDKTx recipients were on dialysis before KTx with over 1/3^rd on dialysis for ≥1 yr. Although increase in pre-emptive KTx among those with LDKTx has been observed over time, it seems to be restricted to the earlier part of last decade. Further studies are needed to explore reasons for lack of utilization of pre-emptive KTx in those who received a LDKTx.

To cite this abstract in AMA style:

Sakhuja A, Naik A, Eikstadt R, Shrivastava P, Cibrik D, Samaniego M. Lack of Utilization of Pre-Emptive Transplantation in Those With Living Donor Kidney Transplants [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/lack-of-utilization-of-pre-emptive-transplantation-in-those-with-living-donor-kidney-transplants/. Accessed June 30, 2025.

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