For patients with advanced chronic kidney disease, getting a preemptive kidney transplant may lead to a longer and healthier life. A preemptive kidney transplant is when a patient receives a new kidney before he or she needs to go on dialysis.
“When we identify a patient’s kidney function is worsening, we want to start the conversation early, well before the need for dialysis, about preemptive kidney transplant through living donation,” says Bernard Fischbach, MD, CCRP, medical director of kidney/pancreas transplantation at Baylor University Medical Center at Dallas, part of Baylor Scott & White Health. “Patients can identify potential donors and recruit family members to be donor champions.”
According to recent studies, a preemptive transplant has many benefits, including lower morbidity and mortality, and lower rates of delayed graft function. The risk of rejection is less, and there is potentially lower immunosuppression if the kidney comes from a family member. Most importantly, patients avoid dialysis.
“We know that patients who get a transplant as a whole do better than those who go on dialysis,” Dr. Fischbach says. “With a preemptive kidney transplant, patients can avoid some of the health problems associated with dialysis. Dialysis can impact bone health and overall cardiovascular health. With living donor kidney transplant, you have improved survival overall and improved quality of life.”
While the benefits of preemptive kidney transplants are well established, rates for this type of transplant are low. At Baylor Scott & White Annette C. and Harold C. Simmons Transplant Institute, living donor kidney transplants account for about 25 percent of all kidney transplants. Of that 25 percent, about half are preemptive kidney transplants. “Interestingly, the trend for related living donors has gone down,” Dr. Fischbach says. “Diabetes and hypertension – two of the most common causes of kidney failure – tend to run in families. It’s not uncommon for a family member to want to donate but are unable to due to these conditions. Today, the majority of living donors are unrelated. I think one factor is paired donation, which has really taken off in the last few years. Also, I think there are a lot of people who want to help other people even if they’re not related.”