Benefits of Preemptive Living Kidney Transplantation: Reduced Rates of Cerebro‐Cardiovascular Events and Neoplasm Development

Objectives Reports on the benefits of preemptive kidney transplantation (PEKT) have been conflicting. We assessed postoperative unfavorable outcomes to determine the potential advantages of PEKT. Methods We conducted a retrospective multicenter study including 567 living donor kidney transplantation recipients registered in the Michinoku Renal Transplant Network database between June 1998 and June 2021. The recipients were classified into two groups: PEKT and non‐PEKT. We compared overall survival, graft survival, rejection‐free survival, cerebro‐cardiovascular disease (CCVD)‐free survival, neoplasm‐free survival, and a combined endpoint (CCVD and/or neoplasm development) between the two groups. To adjust for baseline heterogeneity, we employed inverse probability of treatment weighting (IPTW). Results Of the 567 recipients, 152 (27%) received PEKT and 415 (73%) received non‐PEKT. There were no significant differences in the major outcomes. However, PEKT was significantly associated with a reduced risk of the combined endpoint in both the multivariate Cox regression analysis (hazard ratio [HR]: 0.51, p = 0.029) and the IPTW‐adjusted Cox regression analysis (HR: 0.57, p = 0.019). Conclusions PEKT may confer a potential benefit in reducing the risk of CCVD and/or neoplasm development, although its advantages appear limited for other clinical outcomes.