Does Early Preemptive Kidney Transplantation Reduce Risk of Death?

New research finds that early preemptive kidney transplants do not reduce the risk of death, according to a Yale School of Medicine (YSM) study published in Transplantation Proceedings on March 25.

End-stage kidney disease (ESKD), also known as renal or kidney failure, can occur because of diabetes and high blood pressure, among other reasons. A patient with kidney failure needs a transplant when they begin dialysis, or possibly before. Since dialysis puts stress on the body and weakens the immune system, it is commonly believed that those with ESKD would have better outcomes if they receive a kidney transplant preemptively—before receiving dialysis.

The study, led by Abhishek Kumar, MBBS, associate professor of medicine (nephrology) at YSM and medical director of the Living Kidney Donor Program at Yale, examined records over the span of two decades to evaluate the current state of preemptive kidney transplants in the United States, focusing on mortality benefit. Kumar and his colleagues were interested in finding out whether there was a benefit to performing a transplant earlier versus later from both deceased and living donors.

“If you receive an organ from the deceased donor list, you don’t have control over when you will get the organ,” Kumar says. “On the other hand, if there is a living donor, and you have more control over timing, the question is, when is it most beneficial to get the transplant?”

Our study shows that waiting until you really need a transplant is when you should get one. Otherwise, you're losing that time on your own kidney.
Abhishek Kumar, MBBS

The findings present no difference in outcome of mortality for those who received a kidney transplant earlier when they had a higher estimated glomerular filtration rate (eGFR), a measure of kidney function, or later as eGFR worsened. Therefore, Kumar says, patients should wait if they have a choice. “It’s all about the timing,” says Kumar. “Our study shows that waiting until you really need a transplant is when you should get one. Otherwise, you're losing that time on your own kidney.

“Sometimes I tell patients the best time to get a transplant is the day you need dialysis,” he adds.

Dialysis exposure of up to 6 months does not negatively impact long-term outcomes if a transplantation is performed within that period, Kumar says.

However, the optimal time for dialysis and transplantation depends on the individual and is difficult to predict, says Kumar, who notes that the transition from care of chronic kidney disease to dialysis is costly and resource-intensive. “We should always avoid dialysis if we can, but performing a transplant early is not the solution."

Nephrology is one of ten sections in the Yale Department of Internal Medicine. Committed to excellence in patient care, research, and education, the section’s faculty and trainees aim to be national and international leaders in academic nephrology. To learn more, visit Nephrology.