By Amy Norton

NEW YORK, Mar 08 (Reuters Health) - Getting a kidney transplant early may boost the success of the procedure among seriously ill patients. New research shows that when these patients get a "pre-emptive" kidney transplant--an immediate transplant rather than going on long-term dialysis--they are less likely to see their transplants fail.

Although the findings do not suggest that earlier transplantation is best for all kidney-failure patients, they do indicate that when the disease is bad enough, patients who have the option should get transplants rather than dialysis, Dr. Kevin C. Mange told Reuters Health.

Reviewing the cases of nearly 8,500 patients with total kidney failure, Mange's team found that transplants were more successful among those who received a kidney from a living donor without having undergone long-term dialysis. These transplants are considered pre-emptive and are almost exclusively from living donors, since there are long waiting lists for kidneys from cadavers.

Mange and his colleagues at the University of Pennsylvania in Philadelphia report their findings in the March 8th issue of The New England Journal of Medicine.

The kidneys rid the body of waste and filter toxins from the blood. When they stop working completely, their job must be taken over by either a new kidney or dialysis, a process in which waste products are mechanically filtered from the body. Many patients stay on long-term dialysis before receiving a transplant.

In the case of patients waiting for a kidney from a cadaver, organ shortages are a major reason for long-term dialysis. But, Mange noted, this is not an obstacle when a living donor is available. Yet few pre-emptive kidney transplants are performed in the US each year. About one quarter of kidney transplants among American adults involve living donors, and roughly 25% of those are pre-emptive transplants, according to Mange.

"We should be doing more," he said in an interview.

In their study, Mange and colleagues looked at patients' risk of transplant failure up to 4 years after having the procedure. The investigators found that patients who got a new kidney without prior long-term dialysis were less than half as likely to have the transplant fail within the first year. And the risk continued to fall over subsequent years. Failed transplants included patients who rejected the organ, needed repeat transplants or had to go on long-term dialysis.

What these results mean for seriously ill patients is not fully clear, however. Although earlier transplants may boost the survival of the donated organ, Mange said, "we don't know whether it extends patients' lives."

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