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Push toward pre-emptive kidney transplantation - for sure? | LitMetric

Push toward pre-emptive kidney transplantation - for sure?

Clin Kidney J

INSERM Unit 1018, Team 5, CESP, Hôpital Paul Brousse, Paris-Sud University and Versailles Saint-Quentin-en-Yvelines University, Villejuif, France.

Published: December 2024

AI Article Synopsis

  • Pre-emptive kidney transplantation (PKT) is seen as the best option for patients with end-stage chronic kidney disease (CKD) due to its potential for long-term benefits, but increasing demand for donor organs prompts a reassessment of when to perform these transplants.
  • Recent studies indicate that PKT may not always offer better outcomes compared to non-transplant methods, particularly if performed too early or unnecessarily.
  • The authors suggest developing better prediction models to improve organ allocation and evaluate risks, emphasizing the need for a thoughtful discussion about the timing and appropriateness of PKT for different patients.

Article Abstract

Pre-emptive kidney transplantation (PKT) has long been considered the optimal treatment for patients with end-stage chronic kidney disease (CKD) seeking the most favourable long-term outcomes. However, the significant growth in transplant procedures over recent decades has led to a notable increase in wait-listed patients and a disproportionate demand for donor organs. This situation necessitates a re-evaluation of transplantation timing and the establishment of rational indications from both societal and clinical perspectives. An increasing number of retrospective analyses have challenged the universal benefit of PKT, suggesting that premature indications for living or deceased donor PKT may not always yield superior hard outcomes compared with non-PKT approaches. Conventional predictive models have shown limitations in accurately assessing risks for certain subpopulations, potentially leading to significant disparities among wait-listed patients. To address these challenges, we propose the following considerations. Prediction models should not only optimize the distribution of our limited donor resources, but should also illuminate foreseeable risks associated with a potentially 'unsuccessful' PKT. Therefore, this article seeks to underscore the necessity for further discourse on the smouldering concept of when and for whom living or deceased donor PKT should be considered. Is it universally beneficial, or should the clinical paradigm be re-evaluated? In the endeavour to attain superior post-PKT survival outcomes compared with non-PKT or conservative treatment, it seems critical to acknowledge that other treatments may provide more favourable results for certain individuals. This introduces the intricate task of effectively navigating the complexities associated with 'too early' or 'unsuccessful' PKT.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653007PMC
http://dx.doi.org/10.1093/ckj/sfae335DOI Listing

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