Isaac Kim1
Umberto Maggiore2
Simon R. Knight3
Reshma Rana Magar3
Liset H. M. Pengel3
Frank J. M. F. Dor1,4*- 1Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- 2Dipartimento di Medicina e Chirurgia, Università di Parma, Unità Operativa Nefrologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
- 3Sir Peter Morris Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- 4Department of Surgery and Cancer, Imperial College London, London, United Kingdom
1. Introduction
Kidney transplantation (KT) is the preferred kidney replacement therapy (KRT) for suitable patients with end-stage kidney disease (ESKD) (1). Donor kidneys could be from a deceased donor (DD) or a living donor (LD). LD kidney transplantation (LDKT) is preferred over DD kidney transplantation (DDKT), because of superior quality kidneys that result in improved patient and graft survival (2), greater flexibility for transplantation across the ABO (3, 4) and HLA (5, 6) barriers, and the possibility for kidney exchange (7) including chains initiated by unspecified donors (8). Perhaps the most important advantage of LDKT is the ability to plan the transplant and hence avoid dialysis, thereby offering the most secure way to achieve pre-emptive KT (PKT). This is not entirely possible with DDKT which may occur too early or too late with respect to the onset of ESKD in an era of continuing shortage of DD organs (9).
The very first successful KT in 1954 (10) which took place 6 years before haemodialysis became available as KRT (11) was in-fact pre-emptive.
PKT has many advantages over non-pre-emptive KT (nPKT) and should be considered for all patients eligible for KT. These include longer patient and graft survival (12–15) and avoiding the risks, complications and restrictions of dialysis. Despite these evidence-based advantages of PKT, both in adult (12, 15) and paediatric (13, 14, 16) patients, the clinical reality is that pre-emptive LDKT (PLDKT) rates are disappointing, even in countries with high rates of LDKT, as it is not used as a quality indicator in most countries. This is worthy of discussion, especially if parallels are drawn to other clinical fields such as oncology, where best treatment options according to the latest evidence are strived for.
In this article, we seek to explore what the justifications may be to promote a greater proportion of our patients undergoing PLDKT, and thus advocate for drastic pathway changes to make PLDKT the default KRT that clinical teams should be delivering on.
2. Background
The barriers towards PLDKT have been widely discussed in the literature (17, 18). These include late referral, lack of cohesion, lack of education and insufficient infrastructure and financial support.
Historically, there have been several theoretical drawbacks to PKT raised. These include earlier exposure to the risks of immunosuppression and transplantation surgery (19, 20), potential earlier loss of residual native kidney function and higher risk of non-adherence to immunosuppressants due to not having experienced the morbidity of dialysis (12). The latter fear however has since been disproven (21).
The most common pathway in the United Kingdom (UK) remains DDKT after starting dialysis (22). The UK Renal Registry 24th Annual Report showed that only 17% of all KRT starters are listed or receive LDKT before starting dialysis (23). Between April 2021 and March 2022, only 40% of adult kidney only transplants were from LDs (22) and only 35% of these transplants were pre-emptive (24). In comparison, 50% of kidney transplants in the Netherlands in 2021 were from LDs and a greater proportion of these patients (44%) were pre-emptive (25).
In the UK, median waiting time from start of dialysis to DDKT was 1,044 days for adults transplanted between April 2021 and March 2022 (22). There is substantial mortality on dialysis (26), in addition to a negative impact on employment (27), societal participation (28) and quality of life (QOL) (29, 30). Dialysis also leads to considerable healthcare costs (31). Patients also face a significant risk of suspension from the waiting list (WL) with associated increased mortality and worse graft outcome (32). In comparison to DDKT waiting times, the process of working up an LD to secure PKT is considerably shorter at 90–120 days in the UK (33).
3. Guidelines
Currently, there is limited guidance with regards to PLDKT. Most guidelines recommend LDKT over DDKT but do not comment on PKT (34–37).
The position statement by the Descartes Working Group and the European Renal Best Practise Advisory Board provides strong recommendations in support of PKT and PLDKT (38).
“Guidelines for Living Donor Kidney Transplantation” published jointly by the Renal Association and British Transplantation Society from March 2018 states that “kidney transplantation from a living donor, when available, is the treatment of choice for most patients with end-stage kidney disease” and that “the goal should be pre-emptive transplantation” (39). With regards to children with ESKD, it states, “pre-emptive living related renal transplantation is the gold standard therapy.”
The National Institute for Health and Clinical Excellence recommends including “living donor transplantation in the full informed discussion of options for RRT” and offering “pre-emptive living donor transplant ... or pre-emptive listing for deceased donor transplantation to people considered eligible” (40). Pre-emptive listing for DDKT however does not necessarily translate into high rates of PKT, given the nature of the allocation systems worldwide.
4. COVID
The SARS-CoV-2 pandemic had a profound impact on KT (41) and especially on LDKT with 1,023 fewer adult kidney only transplants being performed in the UK between April 2020 and March 2021 compared to the previous year (42). Only 17% of these transplants were from LDs, compared to 30% the year before, equating to 573 fewer LD kidney transplants. PKT rate was however maintained at 38% and LDKT was more likely to be pre-emptive than DDKT (43).
A similar picture was seen worldwide with KT from LDs decreasing in most countries (44, 45).
5. The public health case
5.1. Cost
The cost and sustainability of healthcare has never been as important given the increasing age of the worldwide population (46).
When directly compared, PLDKT was found to be a “cost-saving strategy compared with non-pre-emptive KT strategies” (47). Compared to maintenance dialysis, LDKT was associated with cost-savings of $94,579 over a 20-year period in one study (29) and “represented a saving of €13,102.97 per patient/year” with a payback period of <1 year in another (30). In the latter study, 89% of the transplants were pre-emptive with the authors concluding that PKT should be encouraged from a health budget perspective (30). PKT avoids the cost of dialysis, which has been estimated to be between £20,660 to £31,785 per patient per year (31), and its complications completely.
Decreasing the number of patients starting dialysis by virtue of undergoing PKT will reduce the need for dialysis capacity, allowing resources to be reallocated elsewhere. Preventing the burden of having dialysis three times a week, may enable patients to continue to work and contribute to society.
5.2. QOL and recipient outcomes
PLDKT is not just cost saving but also beneficial to the patient's QOL and clinical outcomes.
Compared to non-pre-emptive strategies, the quality-adjusted life year (QALY) “gained of PLDKT was 0.47” (47). Furthermore, LDKT when compared with maintenance dialysis added 3.5 QALYs over 20 years (29) and was associated with enhanced QOL (30).
Superior graft and patient survival are seen when comparing PKT to nPKT (12, 14–16). This was the case for both adult (12, 15) and paediatric (13, 14, 16) patients, and well as DDs and LDs (12). This is not surprising, given dialysis vintage prior to transplantation has been demonstrated to negatively impact graft survival and proposed to be the “strongest independent modifiable risk factor for renal transplant outcomes” (48, 49).
5.3. PLDKT vs. pre-emptive DDKT
There has been no direct comparison of PLDKT and pre-emptive DDKT (PDDKT) as identified in a recent systematic review and meta-analysis (50).
There is inherent difficulty in achieving PDDKT as there is no guarantee that pre-emptive listing will lead to PKT. With a DD, it is not possible to know in advance when KT will take place. Furthermore, PDDKT poses ethical dilemmas over the allocation of a scarce resource (51).
6. Donor risk
An important caveat that cannot be ignored is the risk to an LD. These include the risks of surgery (52), albeit very low complication risks if well selected (53), and the consequences of living with one kidney.
Kidney donors have an increased relative risk of ESKD; however, the magnitude of the absolute risk increase is small, and LDs still have a risk of ESKD that is much lower than the general population due to the screening and selection of healthy individuals (54). There is also an increased risk of cardiovascular and all-cause mortality however the authors concluded that they would continue to promote LDKT despite these findings (55). Finally, the ERA-EDTA DESCARTES working group concluded that “living kidney donation should be regarded as an acceptable procedure, as the long-term risks for the donor are generally low and, in many instances, offset by the overall benefit for both the donor and recipient” (56).
It is important to factor in the risk mitigation that takes place for LDs. This includes thorough workup, a focus on operative and anaesthetic safety and yearly follow up post-donation, all according to clear guidelines (39). Annual follow-up means that potential issues such as diabetes and hypertension may be detected earlier than if the individual had not donated allowing effective management. In some countries, such as the Netherlands and the UK, prioritisation on the WL is given should LDs develop ESKD (57).
LDKT, being a planned procedure enables a more thorough work up of the donor, reducing the risk of transmission of infection and/or cancer to the recipient (33). For the healthcare organisation, it permits greater control over theatre, bed and workforce availability. For those without an LD option, increasing LDKT rates will increase the availability of DD kidneys.
7. Equitable access
The UK National Health Service states that “public health contributes to reducing the causes of ill-health and improving people's health and wellbeing through … ensuring that our health services are most effective, most efficient and equally accessible” (58).
We have so far presented the case for PLDKT as the most effective and efficient form of KRT from a public health point of view. What follows is ensuring PLDKT is equally accessible.
The Getting It Right First Time programme national specialty report for renal medicine recommended reducing “unwarranted variation in deceased and living donor transplantation” (1). Inequity in access to KT (59) clearly exists. There is a 22% increase in time to being wait-listed and a 47% increase in time to LDKT for patients of low education level (60). Wide variation was seen in pre-emptive listing rates across centres (59). There is further variation according to age, ethnicity and socioeconomic status in the UK (61, 62) with older age and body mass index of >35 lowering the likelihood of pre-emptive listing (59).
Suggestions to improve PKT rates can be found in the literature. Early referral (63) is vital in ensuring there is time to sort out the logistics of PKT and LD work up. The timing of this referral should take into consideration the individual recipient's circumstances including rate of renal function decline and disease progression (39) rather than being defined by a specific level of renal function alone. Sufficient time should be allowed for patients to discuss donation within their social network to identify potential LDs.
Education to empower the patient through this process is essential (64, 65). A change in healthcare policy to reduce dialysis capacity and increase transplantation capacity have also been put forward (66).
One example of action being taken is the peer phone buddy scheme by the Gift of Living Donation organisation in the UK which seeks to “provide Black African Caribbean patients with … information about living kidney donation from people from their own community who have lived experience of living kidney donation” (67).
Another is the Kidney Team at Home intervention in the Netherlands which has been shown to be a cost-effective way of significantly increasing LDKT (68, 69). This involved group educational intervention of the patient and the patient's social network, in the patient's home.
Although the focus of these interventions is LDKT, strategies to successfully increase PKT largely rely on maximising LDKT.
8. Summary and conclusion
The drastic changes required cannot be understated. The shift from current practice, which sees DDKT after starting dialysis to PLDKT will significantly impact and challenge healthcare systems and practices.
The UK is clear that PLDKT is a major objective as set out in the “Organ donation and transplantation 2030: meeting the need” strategy (70). Another key objective is a more sustainable and reliable system. PLDKT due to its elective nature fulfils these criteria. Although PLDKT cannot fully replace DDKT, maximising its potential would reduce the need to recondition DD organs with expensive technology and infrastructure.
The evidence strongly supports PLDKT as the treatment of choice for ESKD. It is therefore our duty, not only for the individual ESKD patient, but also from a public health perspective, to urgently deliver PLDKT on a much larger scale as the default and in an equitable fashion, and for this to be used as a quality indicator.
Author contributions
IK and FD conceptualised and wrote the article. UM, SK, RR, and LP reviewed and revised the article. All authors contributed to the article and approved the submitted version.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
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References
1. National Health Service. Renal Medicine GIRFT Programme National Specialty Report. (2021). Available online at: https://gettingitrightfirsttime.co.uk/wp-content/uploads/2021/09/Renal-Medicine-Sept21k.pdf (accessed December 12, 2022).
2. Cohen DJ, St Martin L, Christensen LL, Bloom RD, Sung RS. Kidney and pancreas transplantation in the United States, 1995–2004. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. (2006) 6:1153–69. doi: 10.1111/j.1600-6143.2006.01272.x
3. de Weerd AE, van den Brand JAJG, Bouwsma H, de Vries APJ, Dooper IPMM, Sanders JSF, et al. ABO-incompatible kidney transplantation in perspective of deceased donor transplantation and induction strategies: a propensity-matched analysis. Transpl Int Off J Eur Soc Organ Transplant. (2021) 34:2706–19. doi: 10.1111/tri.14145
4. Massie AB, Orandi BJ, Waldram MM, Luo X, Nguyen AQ, Montgomery RA, et al. Impact of ABO-incompatible living donor kidney transplantation on patient survival. Am J Kidney Dis. (2020) 76:616–23. doi: 10.1053/j.ajkd.2020.03.029
5. Koo TY, Lee JH, Min SI, Lee Y, Kim MS, Ha J, et al. Presence of a survival benefit of HLA-incompatible living donor kidney transplantation compared to waiting or HLA-compatible deceased donor kidney transplantation with a long waiting time. Kidney Int. (2021) 100:206–14. doi: 10.1016/j.kint.2021.01.027
6. Orandi BJ, Luo X, Massie AB, Garonzik-Wang JM, Lonze BE, Ahmed R, et al. Survival benefit with kidney transplants from HLA-incompatible live donors. N Engl J Med. (2016) 374:940–50. doi: 10.1056/NEJMoa1508380
7. van de Laar SC, Robb ML, Hogg R, Burnapp L, Papalois VE, Dor FJMF. The Impact of cold ischaemia time on outcomes of living donor kidney transplantation in the UK living kidney sharing scheme. Ann Surg. (2021) 274:859–65. doi: 10.1097/SLA.0000000000005123
8. Ferrari P, Weimar W, Johnson RJ, Lim WH, Tinckam KJ. Kidney paired donation: principles, protocols and programs. Nephrol Dial Transplant. (2015) 30:1276–85. doi: 10.1093/ndt/gfu309
9. Eurotransplant. Active Waiting List (at Year-End) in ALL ET, Median Time Waiting, By Year, By Organ. Available online at: https://statistics.eurotransplant.org/reportloader.php?report=10758-33135&format=html&download=0 (accessed December 12, 2022).
10. Tan SY, Merchant J. Joseph Murray (1919–2012): first transplant surgeon. Singapore Med J. (2019) 60:162–3. doi: 10.11622/smedj.2019032
11. Blagg CR. The 50th anniversary of long-term hemodialysis: University of Washington Hospital, March 9th, 1960. J Nephrol. (2011) 24 Suppl 17:S84–88. doi: 10.5301/JN.2011.6476
12. Kasiske BL, Snyder JJ, Matas AJ, Ellison MD, Gill JS, Kausz AT. Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol JASN. (2002) 13:1358–64. doi: 10.1097/01.ASN.0000013295.11876.C9
13. Amaral S, Sayed BA, Kutner N, Patzer RE. Preemptive kidney transplantation is associated with survival benefits among pediatric patients with end-stage renal disease. Kidney Int. (2016) 90:1100–8. doi: 10.1016/j.kint.2016.07.028
14. Marlais M, Martin K, Marks SD. Improved renal allograft survival for pre-emptive paediatric renal transplant recipients in the UK. Arch Dis Child. (2021) 106:1191–4. doi: 10.1136/archdischild-2020-321277
15. Mange KC, Joffe MM, Feldman HI. Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med. (2001) 344:726–31. doi: 10.1056/NEJM200103083441004
16. Rana Magar R, Knight S, Stojanovic J, Marks SD, Lafranca JA, Turner S, et al. Is preemptive kidney transplantation associated with improved outcomes when compared to non-preemptive kidney transplantation in children? A systematic review and meta-analysis. Transpl Int Off J Eur Soc Organ Transpl. (2022) 35:10315. doi: 10.3389/ti.2022.10315
17. van Dellen D, Burnapp L, Citterio F, Mamode N, Moorlock G, van Assche K, et al. Pre-emptive live donor kidney transplantation-moving barriers to opportunities: an ethical, legal and psychological aspects of organ transplantation view. World J Transplant. (2021) 11:88–98. doi: 10.5500/wjt.v11.i4.88
18. Pradel FG, Jain R, Mullins CD, Vassalotti JA, Bartlett ST. A survey of nephrologists' views on preemptive transplantation. Clin J Am Soc Nephrol CJASN. (2008) 3:1837–45. doi: 10.2215/CJN.00150108
19. Mayo Clinic. Preemptive Kidney Transplant. (2022). Available online at: https://www.mayoclinic.org/tests-procedures/preemptive-kidney-transplant/pyc-20384830 (accessed December 5, 2022).
20. National Kidney Foundation. Why Aren't Preemptive Kidney Transplants More Popular? (2019). Available online at: https://www.kidney.org/newsletter/preemptive-kidney-transplants (accessed December 5, 2022).
21. Vaisbourd Y, Dahhou M, De Simone A, Zhang X, Foster BJ. Differences in medication adherence between preemptive and post-dialysis young kidney transplant recipients. Pediatr Nephrol Berl Ger. (2022) 2022:1–8. doi: 10.1007/s00467-022-05797-7
22. NHS Blood Transplant. Annual Report on Kidney Transplantation 2021/2022. (2022). Available online at: https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/27956/kidney-annual-report-2021-22.pdf (accessed December 12, 2022).
23. UK, Kidney Association. UK Renal Registry 24th Annual Report[[Inline Image]]. Available online at: https://ukkidney.org/sites/renal.org/files/publication/file-attachments/24th_UKRR_ANNUAL_REPORT_BOOK%20version%203_0.pdf (accessed December 14, 2022).
24. NHS Blood Transplant. Annual Report on Kidney Transplantation 2019/2020. (2020). Available online at: https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/20032/kidney-annual-report-2019-20-final.pdf (accessed November 19, 2022).
26. Nefrovisie. RENINE Annual Report. (2021). Available online at: https://www.nefrovisie.nl/wp-content/uploads/2022/02/Jaarrapportage_Renine_2020_web.pdf (accessed November 19, 2022).
27. de Jong RW, Boezeman EJ, Chesnaye NC, Bemelman FJ, Massy ZA, Jager KJ, et al. Work status and work ability of patients receiving kidney replacement therapy: results from a European survey. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc Eur Ren Assoc. (2022) 37:2022–33. doi: 10.1093/ndt/gfab300
28. Purnell TS, Auguste P, Crews DC, Lamprea-Montealegre J, Olufade T, Greer R, et al. Comparison of life participation activities among adults treated by hemodialysis, peritoneal dialysis, and kidney transplantation: a systematic review. Am J Kidney Dis Off J Natl Kidney Found. (2013) 62:953–73. doi: 10.1053/j.ajkd.2013.03.022
29. Matas AJ, Schnitzler M. Payment for living donor (vendor) kidneys: a cost-effectiveness analysis. Am J Transplant Off J Am Soc Transplant Am Soc Transpl Surg. (2004) 4:216–21. doi: 10.1046/j.1600-6143.2003.00290.x
30. Sánchez-Escuredo A, Alsina A, Diekmann F, Revuelta I, Esforzado N, Ricart MJ, et al. Economic analysis of the treatment of end-stage renal disease treatment: living-donor kidney transplantation versus hemodialysis. Transplant Proc. (2015) 47:30–3. doi: 10.1016/j.transproceed.2014.12.005
31. Roberts G, Holmes J, Williams G, Chess J, Hartfiel N, Charles JM, et al. Current costs of dialysis modalities: a comprehensive analysis within the United Kingdom. Perit Dial Int J Int Soc Perit Dial. (2022) 42:578–84. doi: 10.1177/08968608211061126
32. Wallace D, Robb M, Hughes W, Johnson R, Ploeg R, Neuberger J, et al. Outcomes of patients suspended from the national kidney transplant waiting list in the United Kingdom Between 2000 and 2010. Transplantation. (2020) 104:1654–61. doi: 10.1097/TP.0000000000003033
33. NHS Blood Transplant. Living Donor Kidney Transplant. (2022). Available online at: https://www.nhsbt.nhs.uk/organ-transplantation/kidney/receiving-a-kidney/living-donor-kidney-transplant/ (accessed November 19, 2022).
34. Canadian, Blood Services. What is Living Kidney Donation? Available online at: https://www.blood.ca/en/organs-tissues/living-donation/what-is-living-kidney-donation (accessed November 19, 2022).
35. American Society of Transplantation. Living Organ Donation. (2020). Available online at: https://www.myast.org/sites/default/files/Living%20Organ%20Donation%20-%2005-28-2020%20FINAL.pdf (accessed November 19, 2022).
36. Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, et al. KDIGO clinical practice guideline on the evaluation and care of living kidney donors. Transplantation. (2017) 101(8S Suppl 1):S1–109. doi: 10.1097/TP.0000000000001769
37. Uroweb—European Association of Urology. EAU Guidelines on Renal Transplantation—The Guideline—Uroweb. Available online at: https://uroweb.org/guidelines/renal-transplantation/chapter/the-guideline (accessed November 22, 2022).
38. Abramowicz D, Hazzan M, Maggiore U, Peruzzi L, Cochat P, Oberbauer R, et al. Does pre-emptive transplantation versus post start of dialysis transplantation with a kidney from a living donor improve outcomes after transplantation? A systematic literature review and position statement by the Descartes Working Group and ERBP Nephrol Dial Transplant. Off Publ Eur Dial Transpl Assoc Eur Ren Assoc. (2016) 31:691–7. doi: 10.1093/ndt/gfv378
39. British Transplantation Society. Guidelines for Living Donor Kidney Transplantation Fourth Edition. (2018). Available online at: https://bts.org.uk/wp-content/uploads/2018/07/FINAL_LDKT-guidelines_June-2018.pdf (accessed November 19, 2022).
40. The National Institute of Health Care Excellence. Renal Replacement Therapy and Conservative Management. (2018). Available online at: https://www.nice.org.uk/guidance/ng107/resources/renal-replacement-therapy-and-conservative-management-pdf-66141542991301 (accessed November 19, 2022).
41. Chow KM, Maggiore U, Dor FJMF. Ethical issues in kidney transplant and donation during COVID-19 pandemic. Semin Nephrol. (2022) 2022:151272. doi: 10.1016/j.semnephrol.2022.07.006
42. NHS Blood Transplant. Annual Report on Kidney Transplantation 2020/2021. (2021). Available online at: https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/26790/kidney-annual-report-2020-21.pdf (accessed November 19, 2022).
43. NHS Blood Transplant. Annual Report on Living Donor Kidney Transplantation 2020/2021. (2021). Available from: https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/25370/annual-report-on-living-donor-kidney-transplantation-2020-21.pdf (accessed December 5, 2022).
44. International Registry in Organ Donation Transplantation. Final Numbers 2019. (2020). Available online at: https://www.irodat.org/img/database/pdf/Newsletter%20Dec%202020%20.pdf (accessed November 17, 2022).
45. International Registry in Organ Donation Transplantation. Final Numbers 2020. (2021). Available online at: https://www.irodat.org/img/database/pdf/Irodat%20December_final%202020.pdf (accessed November 19, 2022).
46. Office for National Statistics. Living Longer: Is Age 70 the New Age 65? (2019). Available online at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ageing/articles/livinglongerisage70thenewage65/2019-11-19#what-is-population-ageing (accessed November 19, 2022).
47. Phongphithakchai A, Phisalprapa P, Kositamongkol C, Premasathian N, Larpparisuth N, Skulratanasak P, et al. Preemptive living-related kidney transplantation is a cost-saving strategy compared with post-dialysis kidney transplantation in Thailand. Front Med. (2022) 9:869535. doi: 10.3389/fmed.2022.869535
48. Gill JS, Rose C, Joffres Y, Landsberg D, Gill J. Variation in dialysis exposure prior to nonpreemptive living donor kidney transplantation in the United States and its association with allograft outcomes. Am J Kidney Dis Off J Natl Kidney Found. (2018) 71:636–47. doi: 10.1053/j.ajkd.2017.11.012
49. Meier-Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation. (2002) 74:1377–81. doi: 10.1097/00007890-200211270-00005
50. Azegami T, Kounoue N, Sofue T, Yazawa M, Tsujita M, Masutani K, et al. Efficacy of pre-emptive kidney transplantation for adults with end-stage kidney disease: a systematic review and meta-analysis. Ren Fail. (2023) 45:2169618. doi: 10.1080/0886022X.2023.2169618
51. Lee D, Kanellis J, Mulley WR. Allocation of deceased donor kidneys: a review of international practices. Nephrol Carlton Vic. (2019) 24:591–8. doi: 10.1111/nep.13548
52. Bhanot K, Akin EB, Kessaris N, Kimenai D, Minnee RC, Oniscu GC, et al. Live donor nephrectomydonor nephrectomy: current techniques and safety profiles. In:Sharif A, Lipkin G, , editors. Living Kidney Donation: A Practical Guide. (2022) (Cham: Springer International Publishing). p. 149–85.
53. Kortram K, Ijzermans JNM, Dor FJMF. Perioperative events and complications in minimally invasive live donor nephrectomy: a systematic review and meta-analysis. Transplantation. (2016) 100:2264–75. doi: 10.1097/TP.0000000000001327
54. Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, et al. Risk of end-stage renal disease following live kidney donation. JAMA. (2014) 311:579–86. doi: 10.1001/jama.2013.285141
55. Mjøen G, Hallan S, Hartmann A, Foss A, Midtvedt K, Øyen O, et al. Long-term risks for kidney donors. Kidney Int. (2014) 86:162–7. doi: 10.1038/ki.2013.460
56. Maggiore U, Budde K, Heemann U, Hilbrands L, Oberbauer R, Oniscu GC, et al. Long-term risks of kidney living donation: review and position paper by the ERA-EDTA DESCARTES working group. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc Eur Ren Assoc. (2017) 32:216–23. doi: 10.1093/ndt/gfw429
57. NHS Blood Transplant. Living Organ Donors Who Require A Transplant As A Direct Consequence Of Donation. (2015). Available online at: http://odt.nhs.uk/pdf/policy_for_living_organ_donors_requiring_a_transplant_as_a_direct_consequence_of_donation.pdf (accessed December 1, 2022).
58. National Health Service. What is Public Health?. Available online at: https://www.healthcareers.nhs.uk/working-health/working-public-health/what-public-health (accessed November 19, 2022).
59. Pruthi R, Robb ML, Oniscu GC, Tomson C, Bradley A, Forsythe JL, et al. Inequity in access to transplantation in the United Kingdom. Clin J Am Soc Nephrol. (2020) 15:830–42. doi: 10.2215/CJN.11460919
60. Taylor DM, Fraser SDS, Ravanan R, Roderick P. Education, health literacy, and inequity in access to transplantation: findings from the ATTOM cohort study. Lancet. (2017) 390:S88. doi: 10.1016/S0140-6736(17)33023-4
61. Wu DA, Robb ML, Watson CJE, Forsythe JLR, Tomson CRV, Cairns J, et al. Barriers to living donor kidney transplantation in the United Kingdom: a national observational study. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc Eur Ren Assoc. (2017) 32:890–900. doi: 10.1093/ndt/gfx036
62. Bailey PK, Caskey FJ, MacNeill S, Tomson CRV, Dor FJMF, Ben-Shlomo Y. Mediators of socioeconomic inequity in living-donor kidney transplantation: results from a UK multicenter case-control study. Transplant Direct. (2020) 6:e540. doi: 10.1097/TXD.0000000000000986
63. Cass A, Cunningham J, Snelling P, Ayanian JZ. Late referral to a nephrologist reduces access to renal transplantation. Am J Kidney Dis Off J Natl Kidney Found. (2003) 42:1043–9. doi: 10.1016/j.ajkd.2003.07.006
64. Fishbane S, Nair V. Opportunities for increasing the rate of preemptive kidney transplantation. Clin J Am Soc Nephrol CJASN. (2018) 13:1280–2. doi: 10.2215/CJN.02480218
65. Khosla N, Gordon E, Nishi L, Ghossein C. Impact of a chronic kidney disease clinic on preemptive kidney transplantation and transplant wait times. Prog Transplant Aliso Viejo Calif. (2010) 20:216–20. doi: 10.1177/152692481002000304
66. Redeker S, Massey EK, van Merweland RG, Weimar W, Ismail SY, Busschbach JJV. Induced demand in kidney replacement therapy. Health Policy. (2022) 126:1062–8. doi: 10.1016/j.healthpol.2022.07.011
67. GOLD. GOLD—Telephone Buddy Scheme. Gift of Living Donation. Available online at: https://www.giftoflivingdonation.co.uk/gold-telephone-buddy-scheme/ (accessed December 1, 2022).
68. Redeker S, Ismail S, Eeren HV, Massey EK, Weimar W, Oppe M, et al. A dynamic Markov model to assess the cost-effectiveness of the Kidney Team at Home intervention in The Netherlands. Eur J Health Econ HEPAC Health Econ Prev Care. (2022) 23:597–606. doi: 10.1007/s10198-021-01383-0
69. Redeker S, Massey EK, Boonstra C, van Busschbach JJ, Timman R, Brulez HFH, et al. Implementation of the kidney team at home intervention: evaluating generalizability, implementation process, and effects. Transpl Int Off J Eur Soc Organ Transplant. (2021) 34:2317–28. doi: 10.1111/tri.14011
70. NHSBT. Organ Donation and Transplantation 2030: Meeting The Need. Available online at: https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/23463/meeting-the-need-2030.pdf (accessed December 13, 2022).
Keywords: living donor, pre-emptive, kidney transplantation, public health, kidney replacement therapy (KRT), evidence based healthcare, dialysis, end-stage kidney disease (ESKD)
Citation: Kim I, Maggiore U, Knight SR, Rana Magar R, Pengel LHM and Dor FJMF (2023) Pre-emptive living donor kidney transplantation: A public health justification to change the default. Front. Public Health 11:1124453. doi: 10.3389/fpubh.2023.1124453
Received: 15 December 2022; Accepted: 28 February 2023;
Published: 17 March 2023.
Edited by:
Evaldo Favi, IRCCS Ca'Granda Foundation Maggiore Policlinico Hospital, ItalyReviewed by:
Xuhui Zhong, First Hospital, Peking University, ChinaTommaso Maria Manzia, University of Rome Tor Vergata, Italy
Giuseppe Castellano, University of Milan, Italy
Copyright © 2023 Kim, Maggiore, Knight, Rana Magar, Pengel and Dor. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Frank J. M. F. Dor, frank.dor@nhs.net