Rising Trends in Pre-emptive Kidney Transplantation Across Europe: A Two-Decade Analysis

Aug 9 / Esther H S Wong
Kidney transplantation is a critical intervention for individuals with end-stage kidney disease, and pre-emptive kidney transplantation (PEKT)—performed before the need for dialysis—has become an increasingly important consideration.

PEKT can significantly improve patient outcomes by avoiding the complications associated with dialysis, which offers potential economic advantages by reducing the need for costly dialysis treatments.

This study answers the question of how PEKT rates have evolved over time and what barriers need to be overcome. Utilising data from the European Renal Association (ERA) Registry, including contributions from the UK Renal Registry (UKRR), we provide a comprehensive analysis of the trends in PEKT. This analysis sheds light on the factors influencing its prevalence and explores potential initiatives to overcome barriers, encompassing data and insights from across Europe.

Methodology and study design

This observational study analysed adult patients from 12 European countries, including the UK, who received kidney transplants between 2000 and 2019. Using data from the ERA Registry, we examined trends in PEKT rates, identifying factors influencing its prevalence. The study focused on the proportion of PEKT among first-time kidney transplants, changes over time, international differences, and common barriers. Joinpoint regression analysis was used to assess trends and identify significant changes.

Major findings

The study revealed a significant increase in the proportion of PEKT from 7% in 2000 to 18% in 2019, with similar relative increases for both living donor and deceased donor kidney recipients, and notable international differences.

Common barriers include the limited availability of kidney donors and late referrals that led to missed PEKT opportunities. Initiatives such as public education on organ donation and streamlined referral protocols are crucial. These findings underscore the need for ongoing efforts to optimise transplant processes and education to enhance PEKT rates.

Theoretical and practical implications

The study contributes to a deeper theoretical understanding of the factors influencing PEKT rates and the impact of policies and initiatives on pre-emptive kidney transplantation, which also underscores the clinical benefits of PEKT and its potential to reshape the management of kidney failure.

Practically, the findings can guide improvements in clinical practices, transplant referral processes, and patient education to increase the prevalence of PEKT. Theoretically, reducing the need for dialysis through PEKT could lead to significant cost savings for healthcare systems, although these economic benefits need to be quantified through future research.

Study limitations and future research

Limitations include potential data variability and the need for country-specific analyses. Future research should focus on overcoming identified barriers, evaluating the effectiveness of specific initiatives, and comparing long-term economic impacts of PEKT and dialysis.

Conclusion

This study provides valuable insights into the trends and factors influencing European pre-emptive kidney transplantation, highlighting the need for continued efforts to improve PEKT rates. As nephrology continues to evolve, understanding and addressing the factors influencing PEKT rates is crucial for improving patient outcomes and advancing kidney transplantation practices. While theoretical perspectives from health economics suggest that increasing PEKT could reduce reliance on costly dialysis treatments, further research is needed to quantify these economic benefits precisely. This highlights the importance of investigating the economic impact of PEKT to understand its value within the healthcare landscape fully.

Link to published article

Anneke Kramer, Rianne Boenink, Cynthia G Mercado Vergara, Samira Bell, Julia Kerschbaum, Olga L Rodríguez Arévalo, Auxiliadora Mazuecos, Aiko P J de Vries, Anna V Reisæter, Esther H S Wong, Torbjörn Lundgren, María O Valentin, Flor Angel Ordoñez Alvarez, Edoardo Melilli, Patrik Finne, Mårten Segelmark, Cécile Couchoud, Søren S Sørensen, Pietro Manuel Ferraro, Miha Arnol, Mustafa Arici, Alberto Ortiz, Kitty J Jager, Daniel Abramowicz, Vianda S Stel, Rachel Hellemans, Time trends in preemptive kidney transplantation in Europe: an ERA Registry study, Nephrology Dialysis Transplantation, 2024;, gfae105, https://doi.org/10.1093/ndt/gfae105

Definitions of technical terms

  • Pre-emptive Kidney Transplantation (PEKT): Transplanting a kidney into a patient before they need dialysis.
  • Nephrology: The medical field focused on kidney health and diseases.
  • Joinpoint regression analysis: Joinpoint regression analysis is a statistical method used to identify points where a significant change in the trend of a data series occurs. It models data as a series of linear segments joined at these "joinpoints," allowing for the detection of shifts in trends, such as changes in the rate of increase or decrease over time. This method is commonly used in epidemiology, economics, and other fields to analyse trends and determine when and where significant changes have taken place.

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