Published online May 25, 2023. doi: 10.5527/wjn.v12.i3.40
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
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.
Promotion of the rate of PLDKT seems to be a modifiable variable for improvement of the total outcomes of KT.
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.
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.
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.
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.
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.