The comparison of transplant outcomes in preemptive and non-preemptive kidney transplant patients

Objective: Chronic kidney disease is a significant public health issue characterized by high mortality and morbidity rates. The increasing number of patients with end-stage renal disease underscores the importance of treatment options. Among these, kidney transplantation is more advantageous than other therapies as it enhances patient survival and quality of life. However, graft loss remains a significant concern post-transplant. Various factors, including infections, HLA compatibility, comorbidities, and donor type, influence graft survival. This study aims to compare rejection rates, infections, and patient and graft survival between preemptive and non-preemptive kidney transplants. Methods: The study included 121 patients who underwent preemptive kidney transplantation and 175 patients who received non-preemptive transplants between January 2021 and December 2022. Patients aged 18 and over, who underwent transplantation from living or deceased donors at our hospital, were included. This is a retrospective study, and data were obtained from the hospital's automation system and the organ transplantation unit's patient files. We examined various factors, including patients' age, gender, etiologies of chronic kidney disease, type of donor (living or deceased), transplant date, induction and maintenance therapies, graft loss, causes of graft loss, patient mortality, causes of patient mortality, and PCR results for CMV and BK virus, as well as hypertension, diabetes mellitus, HLA and PRA compatibility. The data were analyzed using SPSS version 22.0. Results: It was determined that 40.9% of the patients underwent preemptive kidney transplantation, while 59.1% underwent non-preemptive transplantation. The average age of patients who received preemptive and non-preemptive transplants was found to be statistically similar. Among non-preemptive transplant patients, the proportion of male gender and deceased donor transplants was significantly higher compared to those who received preemptive transplants. No significant differences were found in donor age, donor gender, HLA or PRA data. There was no significant difference in graft survival and overall survival between preemptive and non-preemptive transplant patients. When examining the recipient's age, gender, type of transplant, type of donor, donor age, and donor gender, no parameters affecting graft survival or patient survival could be identified. Conclusion: A retrospective analysis of 296 patients who underwent kidney transplantation revealed no significant differences in graft survival and overall survival based on the type of transplant. There were no significant differences in BK virus, CMV, hypertension, diabetes mellitus, or acute rejection between patients who received preemptive and non-preemptive kidney transplants. However, all of these parameters independently affected graft and patient survival. While kidney transplantation is the most effective treatment for end-stage renal disease, extending graft survival and patient survival is of paramount importance. Although numerous studies have examined graft failure, more research is needed to clarify the associated risk factors.