{"id":2932,"date":"2026-09-06T18:06:21","date_gmt":"2026-09-06T18:06:21","guid":{"rendered":"https:\/\/bookinghospital.org\/?p=2932"},"modified":"2026-09-06T18:12:41","modified_gmt":"2026-09-06T18:12:41","slug":"preemptive-kidney-transplant","status":"publish","type":"post","link":"https:\/\/bookinghospital.org\/ro\/preemptive-kidney-transplant\/","title":{"rendered":"Preemptive Kidney Transplant"},"content":{"rendered":"<div data-elementor-type=\"wp-post\" data-elementor-id=\"2932\" class=\"elementor elementor-2932\">\n\t\t\t\t<div class=\"elementor-element elementor-element-2bba7cb e-con-full e-flex e-con e-parent\" data-id=\"2bba7cb\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c384381 elementor-widget elementor-widget-html\" data-id=\"c384381\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"bh\">\n\n<section class=\"hero\">\n  <div class=\"in\">\n    <p class=\"eyebrow\">Kidney transplantation \u00b7 Before the transplant<\/p>\n    <h1>The best transplant is the one that happens before dialysis.<\/h1>\n    <p class=\"lead\">Every month on dialysis costs you something the transplant cannot give\n       back. Done early enough, a transplant can mean no dialysis at all \u2014 and a realistic\n       chance of returning to your old job.<\/p>\n    <p class=\"meta\">Written by <b style=\"color:#fff\">Profesorul Dr. Murat Tuncer<\/b> \u00b7\n       Adapted from his book <i>Kidney Transplantation \u2014 With Questions and Answers<\/i><\/p>\n  <\/div>\n<\/section>\n\n<section class=\"wrap\">\n\n  <div class=\"ozet\">\n    <h2>The short answer<\/h2>\n    <ul>\n      <li>A <b>preemptive transplant<\/b> is one performed before chronic dialysis begins,\n          when kidney filtration falls <b>below 20 mL\/min<\/b>.<\/li>\n      <li>It is currently the <b>most successful treatment<\/b> available for chronic kidney\n          disease.<\/li>\n      <li>Risk of the transplanted kidney failing in the first year drops by <b>52%<\/b>\n          compared with transplantation after dialysis has started.<\/li>\n      <li>Only <b>24%<\/b> of patients on dialysis for over a year return to work after a\n          transplant. Among preemptive patients, <b>at least half<\/b> do.<\/li>\n      <li>The referral should happen at <b>eGFR below 30<\/b> \u2014 not when dialysis is already\n          being scheduled.<\/li>\n    <\/ul>\n  <\/div>\n\n  <h2>What \"preemptive\" means<\/h2>\n\n  <p>Preemptive kidney transplantation is a transplant performed on a patient with chronic\n     kidney disease <b>before entering a chronic dialysis programme<\/b>, at the point where\n     the glomerular filtration rate falls below 20 mL\/min.<\/p>\n\n  <p>It is not an experimental route or a shortcut. It is the ideal treatment method for\n     chronic kidney disease, and it produces better outcomes than either dialysis or a\n     transplant performed later.<\/p>\n\n  <h2>What the difference actually is<\/h2>\n\n  <p>The advantage over a transplant performed after dialysis has begun is not marginal.<\/p>\n\n  <div class=\"tblwrap\">\n    <table>\n      <thead>\n        <tr><th>Compared with transplant after dialysis<\/th><th>Preemptive transplant<\/th><\/tr>\n      <\/thead>\n      <tbody>\n        <tr>\n          <td>Risk of graft failure, first year<\/td>\n          <td><b>52% lower<\/b><\/td>\n        <\/tr>\n        <tr>\n          <td>Risk of graft failure, second year onwards<\/td>\n          <td><b>86% lower<\/b><\/td>\n        <\/tr>\n        <tr>\n          <td>Rejection rates<\/td>\n          <td>Around <b>25% lower<\/b><\/td>\n        <\/tr>\n        <tr>\n          <td>Return to previous work<\/td>\n          <td><b>At least 50%<\/b>, versus 24% after a year of dialysis<\/td>\n        <\/tr>\n      <\/tbody>\n    <\/table>\n  <\/div>\n\n  <p>Longer time on dialysis is also associated with <b>higher rejection rates in the first six\n     months<\/b> after transplantation. The relationship runs one way: waiting does not improve\n     anything.<\/p>\n\n  <div class=\"box\">\n    <span class=\"etiket\">Beyond the graft<\/span>\n    <p>A preemptive transplant also means avoiding what dialysis itself brings \u2014 infections,\n      blood transfusions (which raise antibody levels and narrow future donor options), cardiac\n      dysfunction and high blood pressure. There are fewer hospitalisations overall, and less\n      delayed graft function.<\/p>\n  <\/div>\n\n  <h2>The part nobody mentions: work<\/h2>\n\n  <p>Survival statistics dominate these conversations, and they should. But for most patients\n     the question underneath is simpler \u2014 <b>will I get my life back?<\/b><\/p>\n\n  <p>Here the numbers are stark. Of patients who have been on dialysis for more than a year,\n     only <b>24%<\/b> return to their jobs after transplantation. Among patients transplanted\n     preemptively, <b>at least half<\/b> return to the work they did before.<\/p>\n\n  <p>Time on dialysis does not only damage the kidney's prospects. It erodes the working life,\n     the routine and the independence that a transplant is supposed to restore.<\/p>\n\n  <div class=\"soru\">\n    <h3>When should this conversation start?<\/h3>\n\n    <p>Earlier than it usually does. There are two thresholds, and they are not the same:<\/p>\n\n    <div class=\"tblwrap\">\n      <table>\n        <thead>\n          <tr><th>Kidney filtration (eGFR)<\/th><th>What should be happening<\/th><\/tr>\n        <\/thead>\n        <tbody>\n          <tr>\n            <td><b>Below 30 mL\/min<\/b><br><span style=\"color:#7a7a7a\">Stage 4<\/span><\/td>\n            <td>Patient education on treatment options \u2014 dialysis <i>and<\/i> transplantation.\n              <b>Referral to a transplant centre.<\/b> This is a referral point, not a dialysis\n              preparation point.<\/td>\n          <\/tr>\n          <tr>\n            <td><b>Below 20 mL\/min<\/b><\/td>\n            <td>Preemptive transplantation should be <b>attempted in all patients<\/b> where it\n              is possible.<\/td>\n          <\/tr>\n          <tr>\n            <td>Below 10 mL\/min<\/td>\n            <td>Dialysis, if a transplant has not happened.<\/td>\n          <\/tr>\n        <\/tbody>\n      <\/table>\n    <\/div>\n\n    <p>The purpose of referring at eGFR 30 rather than 20 is time. The patient needs time to\n       understand the options, complete the transplant evaluation, and \u2014 most importantly \u2014\n       <b>find a potential donor<\/b>. That process cannot be compressed into the last weeks\n       before dialysis.<\/p>\n  <\/div>\n\n  <div class=\"soru\">\n    <h3>Is a transplant more expensive than dialysis?<\/h3>\n\n    <p><b>No \u2014 it is considerably cheaper.<\/b> The cost of caring for a kidney transplant\n       patient is <b>less than one third<\/b> of the cost of long-term dialysis.<\/p>\n\n    <p>Preemptive transplantation reduces it further by avoiding the expensive complications:\n       delayed graft function, acute rejection, graft failure. Where cost is raised as an\n       obstacle, it is worth asking over what time period the comparison was made.<\/p>\n  <\/div>\n\n  <div class=\"box efsane\">\n    <span class=\"etiket\">The gap between what is recommended and what happens<\/span>\n    <p>International guidance sets a target of raising preemptive transplants from\n      <b>26% to 50%<\/b> of all transplants. That target exists because most patients who could\n      have been transplanted before dialysis are not.<\/p>\n    <p>The usual reason is not medical. It is that nobody referred them in time.<\/p>\n  <\/div>\n\n  <h2>What to do with this<\/h2>\n\n  <ul>\n    <li><b>Know your eGFR.<\/b> If it is below 30 and transplantation has not been discussed\n        with you, raise it yourself.<\/li>\n    <li><b>Start looking for a living donor early.<\/b> This is the step that takes longest and\n        the one most often left too late.<\/li>\n    <li><b>Ask how long the evaluation takes at your centre.<\/b> If the preparation period runs\n        to months, the preemptive window may close while you wait.<\/li>\n    <li><b>Avoid unnecessary blood transfusions<\/b> while on dialysis \u2014 each one can raise\n        antibodies and narrow your donor options later.<\/li>\n  <\/ul>\n\n  <div class=\"yazar\">\n    <div class=\"rozet\">MT<\/div>\n    <div>\n      <h3><a href=\"https:\/\/bookinghospital.org\/ro\/murat-tuncer-md\/\" style=\"color:inherit\">Profesorul Dr. Murat Tuncer<\/a><\/h3>\n      <p>Nephrologist and transplant physician. Author of <i>Kidney Transplantation \u2014 With\n        Questions and Answers<\/i> (Istanbul, 2020), written to answer the questions his own\n        patients ask most often.<\/p>\n    <\/div>\n  <\/div>\n\n  <div class=\"cta\">\n    <h2>Send us your eGFR before you start dialysis<\/h2>\n    <p>If your kidney function is falling and no one has raised transplantation, send us your\n       recent tests. We will tell you whether the preemptive window is still open in your case.<\/p>\n    <div class=\"btns\">\n      <a class=\"btn btn-1\" href=\"https:\/\/bookinghospital.org\/ro\/medical-tourism\/\">Send your medical reports<\/a>\n      <a class=\"btn btn-2\" href=\"\/ro\/category\/kidney-transplant-guide\/\">More patient guides<\/a>\n    <\/div>\n  <\/div>\n\n  <div class=\"uyari\">\n    <p><b>Medical disclaimer.<\/b> This article is general information adapted from a published\n      book. It is not personal medical advice, it does not establish a doctor\u2013patient\n      relationship, and it cannot replace assessment by the physician treating you. Thresholds\n      and referral practice differ between patients and centres. Always consult your own\n      nephrologist or transplant centre before making decisions about your treatment.<\/p>\n  <\/div>\n\n  <div class=\"kaynak\">\n    <h3>References<\/h3>\n    <ol>\n      <li>Abecassis M, Bartlett ST, Collins AJ, et al. Kidney transplantation as primary therapy\n        for end-stage renal disease: a National Kidney Foundation \/ Kidney Disease Outcomes\n        Quality Initiative (NKF\/KDOQI) conference.\n        <i>Clin J Am Soc Nephrol<\/i> 2008;3:471\u201380.<\/li>\n      <li>Mange KC, Joffe MM, Feldman HI. Effect of the use or nonuse of long-term dialysis on\n        the subsequent survival of renal transplants from living donors.\n        <i>N Engl J Med<\/i> 2001;344:726\u201331.<\/li>\n      <li>Innocenti GR, Wadei HM, Prieto M, et al. Preemptive living donor kidney\n        transplantation: do the benefits extend to all recipients?\n        <i>Transplantation<\/i> 2007;83:144\u20139.<\/li>\n      <li>Davis CL. Preemptive transplantation and the transplant first initiative.\n        <i>Curr Opin Nephrol Hypertens<\/i> 2010.<\/li>\n      <li>OPTN Minority Affairs Committee. Educational guidance on patient referral to kidney\n        transplantation, 2015.<\/li>\n    <\/ol>\n  <\/div>\n\n<\/section>\n\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Kidney transplantation \u00b7 Before the transplant The best transplant is the one that happens before dialysis. Every month on dialysis costs you something the transplant cannot give back. Done early enough, a transplant can mean no dialysis at all \u2014 and a realistic chance of returning to your old job. Written by Prof. Dr. Murat [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"elementor_header_footer","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"_joinchat":[],"footnotes":""},"categories":[16],"tags":[],"class_list":["post-2932","post","type-post","status-publish","format-standard","hentry","category-kidney-transplant-guide"],"_links":{"self":[{"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/posts\/2932","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/comments?post=2932"}],"version-history":[{"count":4,"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/posts\/2932\/revisions"}],"predecessor-version":[{"id":2937,"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/posts\/2932\/revisions\/2937"}],"wp:attachment":[{"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/media?parent=2932"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/categories?post=2932"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bookinghospital.org\/ro\/wp-json\/wp\/v2\/tags?post=2932"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}