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CDC Ambassador and long-time advocate James Myers is a champion for people battling kidney disease. Unfortunately, when a person’s kidneys begin to fail, there are only two options for treatment: dialysis or transplant. In an expert guest blog, Myers discusses the benefits and barriers to an often overlooked transplant option, a preemptive transplant. WHAT IS A PREEMPTIVE KIDNEY TRANSPLANT? Preemptive transplants take place before a kidney patient starts dialysis – before your kidney function deteriorates to the point where you need dialysis treatment. Between 30% to 40% of all transplants are preemptive transplants, and they are considered to be the preferred method of transplants in comparison to post-dialysis transplants. However, in the United States, only 20% of kidney transplants are preemptive. So, why aren’t they more popular? A preemptive transplant allows the patient to be part of the process and to make their own decisions as it relates to care. As we will see, the benefits of preemptive kidney transplants, by far, outweigh post-dialysis transplants as well as going on dialysis itself. Preemptive transplant allow for surgery before the patient’s medical condition deteriorates and the surgery becomes more difficult and potentially dangerous. The Mayo Clinic cites several factors that contribute to the lower use of preemptive transplants, including a shortage of donor kidneys, lack of access to transplant centers, low rates of physician referrals whose possible recipient candidates have a lower socio-economic status and lack of physician awareness of current guidelines. WHAT ARE THE BENEFITS AND RISKS OF A PREEMPTIVE TRANSPLANT? A preemptive transplant has many benefits to the patient, and among the primary reasons is your body is less likely to reject the new kidney. Furthermore, preemptive transplant recipients often live longer and experience a higher quality of life as there are fewer complications associated with this process. Let’s not forget that preemptive transplants allow patients to forgo dialysis and the costs and possible health complications that accompany this treatment method. With a preemptive transplant, many patients can return to the workforce and provide for themselves and their family. For children who have been diagnosed with kidney failure, preemptive transplants are especially beneficial and allow them to remain active and engaged at school. Some of the risks of preemptive transplants include: early exposure to the associated risks of surgery and the possibility of not using some native kidney function. SO, WHAT’S THE HOLDUP? There are both medical and economic advantages to preemptive transplants. Not only do preemptive transplants lead to improved patient and graft survival, but there are significant health care cost savings associated with early transplantation. Medicare estimates the annual cost for dialysis per patient is $88,000, whereas the annual cost per patient for a kidney transplant is $34,000. Yet, for the last 15 years, only a third of all living donor transplants in the United States are preemptive transplants. There are two factors that contribute to this phenomenon:
  1. Lack of timely referrals from physicians
  2. Delay in completing living donor assessments
Unfortunately, there is a correlation between lack of referrals, education and socioeconomic status. In other words, in the poorer, more uneducated areas of the country, these referrals are not happening! To resolve these issues, transplant programs need to advise and educate patients and referring physicians about the benefits of preemptive transplants as well as their availability. Additionally, it currently takes an average of 10.6 months to complete living donor assessments. During this timeframe, many transplant candidates’ kidney function declines to the point where they must go on dialysis. Donor evaluations should take a matter of weeks, not months. Most potential donors have made a personal and moral commitment to the transplant candidate. Deliberate and unnecessary delays only lead to donor frustration. Expedited referrals and proper education on the issue should lead to more frequent, healthy preemptive transplants. THE BOTTOM LINE Preemptive transplants are the best option for patients. The Mayo Clinic recommends discussing kidney transplantation with your doctors before your kidneys fail. The bottom line is this: Preemptive kidney transplantation recipients have a greater chance of survival and a better quality of life than post-dialysis recipients do.