Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Nephrol. May 25, 2023; 12(3): 40-55
Published online May 25, 2023. doi: 10.5527/wjn.v12.i3.40
Preemptive living donor kidney transplantation: Access, fate, and review of the status in Egypt
Rabea Ahmed Gadelkareem, Amr Mostafa Abdelgawad, Ahmed Reda, Nashwa Mostafa Azoz, Mohammed Ali Zarzour, Nasreldin Mohammed, Hisham Mokhtar Hammouda, Mahmoud Khalil
Rabea Ahmed Gadelkareem, Amr Mostafa Abdelgawad, Ahmed Reda, Mohammed Ali Zarzour, Nasreldin Mohammed, Hisham Mokhtar Hammouda, Mahmoud Khalil, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Nashwa Mostafa Azoz, Department of Internal Medicine, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Author contributions: Gadelkareem RA, Abdelgawad AM, and Zarzour MA designed the research, collected the data, and wrote the paper; Reda A, Azoz NM, and Mohammed N contributed to the statistical analysis, literature review, writing and revision; Hammouda HM and Khalil M contributed to the literature review, writing, revision and supervision of the work; All authors approved the paper.
Institutional review board statement: This study has been approved in 2017 by the Medical Ethics Committee of the Faculty of Medicine, Assiut University, Egypt as a topic in a research project titled "Outcome of living donor kidney transplantation in Assiut Urology and Nephrology Hospital". The institutional review board number is 17200148.
Informed consent statement: This article is a retrospective study. Patients were not required to give informed consent to the study because the manipulated data were anonymous and were obtained after each patient agreed to treatment by consent.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: The data supporting this study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rabea Ahmed Gadelkareem, MD, Assistant Professor, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut 71515, Egypt. rabeagad@aun.edu.eg
Received: January 11, 2023
Peer-review started: January 11, 2023
First decision: February 2, 2023
Revised: February 22, 2023
Accepted: March 14, 2023
Article in press: March 14, 2023
Published online: May 25, 2023
Processing time: 121 Days and 16.2 Hours
Abstract
BACKGROUND

Preemptive living donor kidney transplantation (PLDKT) is recommended as the optimal treatment for end-stage renal disease.

AIM

To assess the rate of PLDKT among patients who accessed KT in our center and review the status of PLDKT in Egypt.

METHODS

We performed a retrospective review of the patients who accessed KT in our center from November 2015 to November 2022. In addition, the PLDKT status in Egypt was reviewed relative to the literature.

RESULTS

Of the 304 patients who accessed KT, 32 patients (10.5%) had preemptive access to KT (PAKT). The means of age and estimated glomerular filtration rate were 31.7 ± 13 years and 12.8 ± 3.5 mL/min/1.73 m2, respectively. Fifty-nine patients had KT, including 3 PLDKTs only (5.1% of total KTs and 9.4% of PAKT). Twenty-nine patients (90.6%) failed to receive PLDKT due to donor unavailability (25%), exclusion (28.6%), regression from donation (3.6%), and patient regression on starting dialysis (39.3%). In multivariate analysis, known primary kidney disease (P = 0.002), patient age (P = 0.031) and sex (P = 0.001) were independent predictors of achievement of KT in our center. However, PAKT was not significantly (P = 0.065) associated with the achievement of KT. Review of the literature revealed lower rates of PLDKT in Egypt than those in the literature.

CONCLUSION

Patient age, sex, and primary kidney disease are independent predictors of achieving living donor KT. Despite its non-significant effect, PAKT may enhance the low rates of PLDKT. The main causes of non-achievement of PLDKT were patient regression on starting regular dialysis and donor unavailability or exclusion.

Keywords: Access to kidney transplantation; Donor regression; Kidney transplantation; Living donors; Preemptive kidney transplantation; Transplantation

Core Tip: Patients with preemptive access to kidney transplantation (PAKT) may have significant differences from those with conventional access to KT, warranting more evaluation. In this study, known primary kidney disease was an independent factor of achievement of living donor KT (LDKT). In addition, the older age and female sex were independent predictors of non-achievement of LDKT. However, unavailability, regression, and exclusion of LDs and patient regression on starting dialysis may prevent achievement of preemptive LDKT (PLDKT) in patients with PAKT. Despite its non-significant effect, PAKT may improve the low rates of PLDKT. The current literature review may refer to that PLDKT has comparable or variably better outcomes than the conventional LDKT. Hence, PLDKT is recommended as the first choice for each candidate patient. In Egypt, the rate of PLDKT is still lower than that of other countries, warranting implementation of effective strategies to promote PLDKT.