A Single-Center, Retrospective Comparison of Non-Pre-emptive with Pre-emptive Renal Transplantations

Introduction. End-stage renal disease (ESRD) requires renal replacement therapy, either through pre-emptive transplantation (PET) or non-pre-emptive transplantation (non-PET). PET is associated with improved patient and allograft survival compared to non-PET; however, only 2.5% of patients in the United States undergo PET. The authors of this study report on mortality and allograft rejection rates in patients undergoing PET versus non-PET. Methods. This single-center, retrospective study compared post-transplant complications between PET and non-PET in adults with ESRD. De-identified electronic health record data from 2017 to 2022 were analyzed. Odds ratios (ORs) for one-year post-transplant mortality and allograft rejection were calculated using unadjusted multivariate logistic regression (Model 1), adjusted for age and sex (Model 2), and further adjusted for comorbidities (Model 3). Results. Of 787 patients with ESRD who underwent kidney transplantation, 14% of patients experienced PTD and 86% experienced PET. Comparing PTD to PET, the OR for 1-year-postoperative mortality in Model 1 was 1.76 (95%CI 0.64-4.85; p=0.27), in Model 2 was 2.02 (95%CI 0.71-5.71; p=0.19) and in Model 3 was 1.86 (95%CI 0.64-5.39; p=0.24). Comparing PTD to PET, the ORs for 1-year postoperative transplant rejection in Model 1 was 1.63 (95%CI 0.85-3.10; p=0.13), in Model 2 was 1.61 (95%CI 0.84 -3.06; p=0.15) and in Model 3 was 1.60 (95%CI 0.82-3.10; p=0.16). Conclusions. This single-center investigation found no significant difference between the renal replacement therapy options for ESRD.