Graft Survival in Preemptive Renal Transplantation in Children

Objective: Preemptive kidney transplantation (PKT) is an effective treatment modality that avoids the complications related to dialysis. However, the effect of PKT on graft survival remains controversial. This study aimed to compare graft survival in pediatric recipients of PKT with that of non-PKT recipients. Materials and Methods: The medical records of pediatric kidney transplant recipients between 2005 and 2017 were retrospectively reviewed. We compared glomerular filtration rate, graft, and patient survival rates receiving PKT versus non-PKT. Results: A total of 230 pediatric recipients were included in the study. The majority of recipients were boys (60.4%) who received a living donor kidney (70.8%). In the study group, 46.1% of the patients underwent PKT; 27.8% were on peritoneal dialysis and 26.1% on hemodialysis in the pre-transplant period. The rates of antibody-mediated rejection and BK virus nephropathy were similar between recipients with PKT and non-PKT (p=1.000 and 0.643, respectively). The 3-year graft and patient survival rates were similar between patients with PKT and non-PKT (95.2% vs 93.5%; p=0.776 and 98.1% vs 97.5%; p=1.000, respectively). The dialysis duration, rejection within 6 months after transplantation, and antibody-mediated rejection were independent risk factors for graft failure [Odds ratio (OR) 1.013; 95% confidence interval (CI) 0.992-1.034; p=0.031, OR 0.068; 95% CI 0.105-0.326; p=0.025, and OR 6.029; 95% CI 2.018-7.106; p<0.001]. Conclusion: Evaluation of graft and patient survival shows that PKT is a safe and effective renal replacement treatment option.