Preemptive kidney transplantation

Pre-emptive transplantation is allowing to carry out renal transplantation before starting dialysis therapy. According to European Guidelines patient with end stage renal disease (ESRD) has to be qualified to the transplant waiting list when his glomerular filtration rate (EGFR) is below 15 ml/min/1.73 m2 in non-diabetic patients or below 20 ml/min/1.73 m2 (diabetic patients). There are several benefits of pre-emptive transplantation, like: better longtherm survival both patients and grafts, avoiding dialysis and its potential complications, diminishing severe diabetic complications, better physical and psychological progress in children and adolescents possibility of education and/or work continuation. Last but not last one have to take into account that this method is giving better economical results in the treatment of ESRD patients comparing with other renal replacement therapy methods. There are also some arguments raised by opponents of this method like some risk connected with tranplantation procedure in people with still working, even very badly, kidneys, difficulty with determining the best moment for transplantation and/or prolonging waiting time for dialysed patients. Nondialysed patients are more or less taking 3% registered on the waiting list. Potential increment of this percentage is dependent from the existence of efficient system of nephrological care with early determination and referral of patients with chronic kidney disease (CKD). This kind of system is allowing from one side early, better and more efficient nephroprotection and from the other point of view early qualification of patient to renal replacement therapy. This process qualification and allocation is similar to that which is commonly used in dialysed patient. Nevertheless it is necessary to change our way of thinking and starting to qualify patients not to dialysis but earlier to renal replacement therapy with hope that first method will be pre-emptive transplantation. Introduction of this system needs wide education of medical community and also performed among patients with CKD. Results of our pre- emptive renal transplantation program introduced in Gdańsk five years ago are showing clearly that it is worthwhile to introduce and expand such system commonly in our country taking into account medical and socioeconomical reasons.

Keywords: Kidney Transplantation, renal transplantation