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Preemptive kidney transplantation: a propensity score matched cohort study

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Abstract

Background

The reasons for improved outcomes associated with preemptive kidney transplantation (PKT) are incompletely understood, and post-transplant complications have been scarcely investigated.

Methods

We evaluated the outcomes of PKT in both unmatched (n = 1060) and propensity score matched cohorts (n = 186) of adults who underwent living kidney transplant between 2000 and 2014. Outcomes were estimated glomerular filtration rate (eGFR), biopsy-proven rejection, cytomegalovirus (CMV) infection, post-transplant diabetes mellitus (PTDM), cardiovascular disease (CVD), graft failure (non-censored for death), and malignancy. Primary endpoint was post-transplant renal function assessed with eGFR.

Results

A total of 95 patients (9.0 %) underwent PKT. The 2-week mean eGFR after transplant was comparable between the matched PKT and non-PKT groups (45.2 vs. 46.5 mL/min/1.73 m2, respectively, P = 0.56). Sensitivity analysis using various formulas did not change the results. PKT was not superior to non-PKT in reducing the risk of biopsy-proven rejection, CMV, PTDM, and malignancy, regardless of matching. The risk of graft failure and CVD was significantly reduced in the unmatched PKT group (ARR, −6.2 %; 95 % CI, −8.6 to −0.7; P = 0.03, and ARR, −6.7 %; 95 % CI, −9.6 to −0.7, P = 0.03, respectively); nevertheless, the corresponding ARRs were −3.2 % (95 % CI, −10.0 to 2.9; P = 0.44) and −2.2 % (95 % CI, −9.1 to 4.4; P = 0.72) after matching.

Conclusions

PKT was associated with neither improvement of post-transplant renal function nor a lower rate of common post-transplant complications than non-PKT among patients with end-stage renal disease who underwent living KT.

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References

  1. Meier-Kriesche HU, Port FK, Ojo AO, et al. Effect of waiting time on renal transplant outcome. Kidney Int. 2000;58(3):1311–7.

    Article  CAS  PubMed  Google Scholar 

  2. Mange KC, Joffe MM, Feldman HI. Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med. 2001;344(10):726–31.

    Article  CAS  PubMed  Google Scholar 

  3. Kasiske BL, Snyder JJ, Matas AJ, et al. Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol. 2002;13(5):1358–64.

    Article  PubMed  Google Scholar 

  4. Wang AY, Lai KN. The importance of residual renal function in dialysis patients. Kidney Int. 2006;69(10):1726–32.

    Article  PubMed  Google Scholar 

  5. Ishani A, Ibrahim HN, Gilbertson D, et al. The impact of residual renal function on graft and patient survival rates in recipients of preemptive renal transplants. Am J Kidney Dis. 2003;42(6):1275–82.

    Article  PubMed  Google Scholar 

  6. Akkina SK, Connaire JJ, Snyder JJ, et al. Earlier is not necessarily better in preemptive kidney transplantation. Am J Transplant. 2008;8(10):2071–6.

    Article  CAS  PubMed  Google Scholar 

  7. Grams ME, Massie AB, Coresh J, et al. Trends in the timing of pre-emptive kidney transplantation. J Am Soc Nephrol. 2011;22(9):1615–20.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Huang Y, Samaniego M. Preemptive kidney transplantation: has it come of age? Nephrol Ther. 2012;8(6):428–32.

    Article  PubMed  Google Scholar 

  9. Abramowicz D, Hazzan M, Maggiore U, et al. Does pre-emptive transplantation versus post start of dialysis transplantation with a kidney from a living donor improve outcomes after transplantation? A systematic literature review and position statement by the Descartes Working Group and ERBP. Nephrol Dial Transplant. 2016;31(5):691–7.

    Article  PubMed  Google Scholar 

  10. Okumi M, Unagami K, Tachibana H, et al. Association between body mass index and outcomes in Japanese living kidney transplant recipients: The role of sex differences. Int J Urol. 2016;23(9):776–8.

    Article  PubMed  Google Scholar 

  11. Okumi M, Toki D, Nozaki T, et al. ABO-incompatible living kidney transplants: evolution of outcomes and immunosuppressive management. Am J Transpl. 2016;16(3):886–96.

    Article  CAS  Google Scholar 

  12. Rubin DB, Thomas N. Matching using estimated propensity scores: relating theory to practice. Biometrics. 1996;52(1):249–64.

    Article  CAS  PubMed  Google Scholar 

  13. Matsuo S, Imai E, Horio M, et al. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92.

    Article  CAS  PubMed  Google Scholar 

  14. Levey AS, Coresh J, Greene T, et al. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med. 2006;145(4):247–54.

    Article  CAS  PubMed  Google Scholar 

  15. Levey AS, Stevens LA, Schmid CH, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31–41.

    Article  CAS  PubMed  Google Scholar 

  17. Newcombe RG. Interval estimation for the difference between independent proportions: comparison of eleven methods. Stat Med. 1998;17(8):873–90.

    Article  CAS  PubMed  Google Scholar 

  18. Friedewald JJ, Reese PP. The kidney-first initiative: what is the current status of preemptive transplantation? Adv Chronic Kidney Dis. 2012;19(4):252–6.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Goto N, Okada M, Yamamoto T, et al. Association of dialysis duration with outcomes after transplantation in a japanese cohort. Clin J Am Soc Nephrol. 2016;11(3):497–504.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. D’Cunha PT, Parasuraman R, Venkat KK. Rapid resolution of proteinuria of native kidney origin following live donor renal transplantation. Am J Transplant. 2005;5(2):351–5.

    Article  PubMed  Google Scholar 

  21. Becker BN, Rush SH, Dykstra DM, et al. Preemptive transplantation for patients with diabetes-related kidney disease. Arch Intern Med. 2006;166(1):44–8.

    Article  PubMed  Google Scholar 

  22. Gill JS, Tonelli M, Johnson N, et al. Why do preemptive kidney transplant recipients have an allograft survival advantage? Transplantation. 2004;78(6):873–9.

    Article  PubMed  Google Scholar 

  23. Cooper BA, Branley P, Bulfone L, et al. A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med. 2010;363(7):609–19.

    Article  CAS  PubMed  Google Scholar 

  24. Lefaucheur C, Loupy A, Hill GS, et al. Preexisting donor-specific HLA antibodies predict outcome in kidney transplantation. J Am Soc Nephrol. 2010;21(8):1398–406.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ekberg H, Tedesco-Silva H, Demirbas A, et al. Reduced exposure to calcineurin inhibitors in renal transplantation. N Engl J Med. 2007;357(25):2562–75.

    Article  CAS  PubMed  Google Scholar 

  26. Webster AC, Playford EG, Higgins G, et al. Interleukin 2 receptor antagonists for renal transplant recipients: a meta-analysis of randomized trials. Transplantation. 2004;77(2):166–76.

    Article  CAS  PubMed  Google Scholar 

  27. Rostaing L, Bunnapradist S, Grinyo JM, et al. Novel once-daily extended-release tacrolimus versus twice-daily tacrolimus in de novo kidney transplant recipients: two-year results of phase 3, double-blind, randomized trial. Am J Kidney Dis. 2016;67(4):648–59.

    Article  CAS  PubMed  Google Scholar 

  28. Kutner NG, Zhang R, Huang Y, et al. Impact of race on predialysis discussions and kidney transplant preemptive wait-listing. Am J Nephrol. 2012;35(4):305–11.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tripepi G, Jager KJ, Dekker FW, et al. Bias in clinical research. Kidney Int. 2008;73(2):148–53.

    Article  CAS  PubMed  Google Scholar 

  30. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics-2016 Update: a Report From the American Heart Association. Circulation. 2016;133(4):e38–360.

    Article  PubMed  Google Scholar 

  31. Goodkin DA, Bragg-Gresham JL, Koenig KG, et al. Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol. 2003;14(12):3270–7.

    Article  PubMed  Google Scholar 

  32. Tripepi G, Jager KJ, Dekker FW, et al. Measures of effect: relative risks, odds ratios, risk difference, and ‘number needed to treat’. Kidney Int. 2007;72(7):789–91.

    Article  CAS  PubMed  Google Scholar 

  33. Bock ME, Cohn RA. Pre-emptive kidney transplantation—just do it! Pediatr Transplant. 2010;14(5):561–4.

    Article  PubMed  Google Scholar 

  34. Weng FL, Mange KC. A comparison of persons who present for preemptive and nonpreemptive kidney transplantation. Am J Kidney Dis. 2003;42(5):1050–7.

    Article  PubMed  Google Scholar 

  35. Ferrari P, Weimar W, Johnson RJ, et al. Kidney paired donation: principles, protocols and programs. Nephrol Dial Transplant. 2015;30(8):1276–85.

    Article  PubMed  Google Scholar 

  36. Knoll G, Cockfield S, Blydt-Hansen T, et al. Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation. CMAJ. 2005;173(10):S1–25.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Maggiore U, Oberbauer R, Pascual J, et al. Strategies to increase the donor pool and access to kidney transplantation: an international perspective. Nephrol Dial Transplant. 2015;30(2):217–22.

    Article  PubMed  Google Scholar 

  38. Andrews PA, Burnapp L, Manas D, et al. Summary of the British Transplantation Society/Renal Association U.K. guidelines for living donor kidney transplantation. Transplantation. 2012;93(7):666–73.

    Article  PubMed  Google Scholar 

  39. Jay CL, Dean PG, Helmick RA, et al. Reassessing preemptive kidney transplantation in the United States: are we making progress? Transplantation. 2016;100(5):1120–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

We appreciate the support provided by Katsunori Shimada, PhD (STATZ Institute, Inc., Tokyo, Japan), who provided expert assistance with statistical analysis. Astellas Pharma Inc. (Tokyo, Japan) supported this study with a grant. The sponsor was not involved in the study design, patient enrollment, data collection, analysis, interpretation, or preparation of the manuscript.

JACK Investigators

Department of Urology, Tokyo Women’s Medical University: Kazunari Tanabe (principal investigator), Hideki Ishida, Masashi Inui, Tomokazu Shimizu, Masayoshi Okumi, Toshihito Hirai, and Daisuke Toki. Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital: Hiroshi Toma and Kazuya Omoto. Department of Urology, Ohkubo Hospital: Hiroki Shirakawa.

Transplant Coordinator

Department of Urology, Tokyo Women’s Medical University: Miyuki Furusawa

Clinical Research Coordinator

Department of Urology, Tokyo Women’s Medical University: Makiko Fujiwara and Kayo Kusubayashi.

Biostatistics and Data Center

Department of Biostatistics, STATZ Institute, Inc., Tokyo, Japan: Katsunori Shimada.

Author information

Authors and Affiliations

  1. Department of Urology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan

    Masayoshi Okumi, Yasuyuki Sato, Toshihito Hirai, Hideki Ishida & Kazunari Tanabe

  2. Department of Medicine, Kidney Center, Tokyo Women’s Medical University, Tokyo, Japan

    Kohei Unagami

Authors
  1. Masayoshi Okumi
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  2. Yasuyuki Sato
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  3. Kohei Unagami
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  4. Toshihito Hirai
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  5. Hideki Ishida
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  6. Kazunari Tanabe
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Consortia

The Japan Academic Consortium of Kidney Transplantation (JACK)

Corresponding author

Correspondence to Masayoshi Okumi.

Ethics declarations

The study was carried out according to the principles of the Declaration of Helsinki. This study protocol was approved by the research ethics committee (Approval No.: 3366-R). Information for the JACK study has been provided in the registration with the University Hospital Medical Information Network (UMIN000018327).

Conflict of interest

None of the authors have any of conflict of interest to declare with regard to the content of this article.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Okumi, M., Sato, Y., Unagami, K. et al. Preemptive kidney transplantation: a propensity score matched cohort study. Clin Exp Nephrol 21, 1105–1112 (2017). https://doi.org/10.1007/s10157-016-1345-x

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  • DOI: https://doi.org/10.1007/s10157-016-1345-x

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