The Japanese Journal of Clinical Dialysis Vol.28 No.13(9)

Theme Considering the timing of chronic dialysis (renal replacement therapy) initiation
Title Timing of preemptive kidney transplantation
Publish Date 2012/12
Author Seiichiro Shishido Department of Pediatric Nephrology, Toho University School of Medicine
[ Summary ] Recently, nearly 25 % of living donor kidney transplants (KT) and 10 % of deceased donor KT cases proceeded without the institution of dialysis. Moreover, 34 % of primary living donor KT and 13 % of deceased donor KT cases involved preemptive treatment of children. This was because these patients had never received maintenance dialysis. Preemptive kidney transplantation (PEKT) offers a significant advantage to recipients by minimizing the disruptive effects of dialysis. Furthermore, adult studies have shown that graft survival rates are better in preemptive transplant recipients compared to recipients who have received pretransplant dialysis. The longer the duration of pretransplant dialysis, the worse the graft survival rates are. It has also been shown this modality reduces the cost of renal replacement therapy. Better long-term graft outcomes have also been demonstrated in many pediatric studies, although pediatric data related to this subject are limited. Therefore, PEKT is expected to become more prevalent in Japan in the near feature.
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