Pre-emptive kidney transplant
Morales Ruiz, E.
Nefrologia Publicacion Oficial de la Sociedad Espanola Nefrologia 28(Suppl 3): 123-128
2008
ISSN/ISBN: 0211-6995 PMID: 19018750 Document Number: 621294
- Kidney transplant is nowadays an indisputable treatment, which has been shown to improve both the quantity and quality of life of patients with end-stage kidney disease (Strength of Recommendation A). - Time on dialysis is one of the factors associated with poor prognosis for graft and patient survival (Strength of Recommendation B). - Early kidney transplant avoids the inconveniences caused by dialysis techniques and the expenditure generated by them (Strength of Recommendation B). - Early kidney transplant from a living or cadaver donor has shown better graft and recipient survival results than kidney transplant performed in patients on dialysis (Strength of Recommendation B). - Early kidney transplant should be offered to all patients who are candidates for a living donor kidney. In the case of a cadaver donor, early kidney transplant can be an ideal option for all candidates, but in particular for children and patients with diabetic nephropathy. However, it should not be forgotten that there is a limited supply of cadaver donors (Strength of Recommendation B). - In patients over 65 years of age, kidney transplant should be considered as a treatment option since it increase life expectancy compared to dialysis (Strength of Recommendation B). - We should promote strategies to combat the shortage of organs (promote living donor transplant, use of suboptimal donors, asystolic donors, etc.) and so be able to consider the option of early kidney transplant (Strength of Recommendation C). - The ideal time for patients with chronic kidney disease to be included on the waiting list for a kidney transplant should be when their glomerular filtration rate is less than 15-20 ml/min and we can foresee that the time for their inclusion in dialysis will no extend beyond 1 to 2 years (Strength of Recommendation C). - We should not forget that the time on the waiting list for a kidney transplant is exactly the same for all patients with chronic kidney disease whether or not they are on dialysis (Strength of Recommendation C). In conclusion, we can state that there is a sufficiently solid scientific basis for attempting that patients receive the option of a kidney transplant before their inclusion in dialysis.