Preemptive living donor kidney transplantation: Access, fate, and review of the status in Egypt

Rabea Ahmed Gadelkareem; Amr Mostafa Abdelgawad; Ahmed Reda; Nashwa Mostafa Azoz; Mohammed Ali Zarzour; Nasreldin Mohammed; Hisham Mokhtar Hammouda; Mahmoud Khalil

doi:10.5527/wjn.v12.i3.40

Preemptive living donor kidney transplantation: Access, fate, and review of the status in Egypt

World J Nephrol. 2023 May 25;12(3):40-55. doi: 10.5527/wjn.v12.i3.40.

Authors

Rabea Ahmed Gadelkareem¹, Amr Mostafa Abdelgawad², Ahmed Reda², Nashwa Mostafa Azoz³, Mohammed Ali Zarzour², Nasreldin Mohammed², Hisham Mokhtar Hammouda², Mahmoud Khalil²

Affiliations

¹ Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt. rabeagad@aun.edu.eg.
² Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt.
³ Department of Internal Medicine, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt.

Abstract

Background: Preemptive living donor kidney transplantation (PLDKT) is recommended as the optimal treatment for end-stage renal disease.

Aim: To assess the rate of PLDKT among patients who accessed KT in our center and review the status of PLDKT in Egypt.

Methods: We performed a retrospective review of the patients who accessed KT in our center from November 2015 to November 2022. In addition, the PLDKT status in Egypt was reviewed relative to the literature.

Results: Of the 304 patients who accessed KT, 32 patients (10.5%) had preemptive access to KT (PAKT). The means of age and estimated glomerular filtration rate were 31.7 ± 13 years and 12.8 ± 3.5 mL/min/1.73 m², respectively. Fifty-nine patients had KT, including 3 PLDKTs only (5.1% of total KTs and 9.4% of PAKT). Twenty-nine patients (90.6%) failed to receive PLDKT due to donor unavailability (25%), exclusion (28.6%), regression from donation (3.6%), and patient regression on starting dialysis (39.3%). In multivariate analysis, known primary kidney disease (P = 0.002), patient age (P = 0.031) and sex (P = 0.001) were independent predictors of achievement of KT in our center. However, PAKT was not significantly (P = 0.065) associated with the achievement of KT. Review of the literature revealed lower rates of PLDKT in Egypt than those in the literature.

Conclusion: Patient age, sex, and primary kidney disease are independent predictors of achieving living donor KT. Despite its non-significant effect, PAKT may enhance the low rates of PLDKT. The main causes of non-achievement of PLDKT were patient regression on starting regular dialysis and donor unavailability or exclusion.

Keywords: Access to kidney transplantation; Donor regression; Kidney transplantation; Living donors; Preemptive kidney transplantation; Transplantation.