Preemptive Kidney Transplantation
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Abstract
Currently, kidney transplantation (KT) is considered the best mode of renal replacement therapy (RRT) because it offers a better quality of life and overall survival compared to other options. Clinical practice guidelines typically recommend preemptive KT before the patient starts dialysis due to its superior clinical outcomes. These outcomes include better graft and patient survival, a lower acute rejection rate, and cost-effectiveness compared to KT after dialysis. However, several barriers hinder the widespread adoption of preemptive KT, such as limited donor availability, the readiness of recipients, and reimbursement issues. Given the increasing number of patients with end-stage kidney disease requiring RRT globally, including in Thailand, preemptive KT should be considered the first and preferred choice of RRT for these patients. This review focuses on the advantages and barriers of preemptive KT, the appropriate time to begin the preparation process, and potential solutions to increase the number of preemptive KTs in Thailand.
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