Gadelkareem RA, Abdelgawad AM, Reda A, Azoz NM, Zarzour MA, Mohammed N, Hammouda HM, Khalil M. Preemptive living donor kidney transplantation: Access, fate, and review of the status in Egypt. World J Nephrol 2023; 12(3): 40-55 [PMID: 37476008 DOI: 10.5527/wjn.v12.i3.40]
Corresponding Author of This Article
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
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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
ARTICLE HIGHLIGHTS
Research background
Despite its low rates, preemptive living donor kidney transplantation (PLDKT) is recommended as the optimal treatment for end-stage renal disease. However, its rate is still lower than the expected rates worldwide.
Research motivation
Promotion of the rate of PLDKT seems to be a modifiable variable for improvement of the total outcomes of KT.
Research objectives
To assess the rate of achievement of PLDKT among patients accessing KT in our center and to review the status of PLDKT in Egypt in the context of the international literature.
Research methods
We performed a retrospective review of the records of patients who accessed KT in our center from November 2015 to November 2022. The demographic and clinical characteristics of the patients and their potential donors were reviewed. Also, the literature was reviewed for PLDKT status in Egypt.
Research results
Of 304 patients 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 three PLDKTs only (5.1% of the 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, including the current results, than the internationally reported rates.
Research conclusions
Patient age, sex, and primary kidney disease are independent predictors of achieving LDKT. Despite its non-significant effect, PAKT may improve 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.
Research perspectives
Studying the factors that may promote the early access of ESRD patients to KT may improve the rates of PLDKT. This latter strategy may improve the whole outcomes of the process of KT, including avoidance of the inconveniences of dialysis and improvement of the graft and patient survival rates.
