Time trends in pre-emptive kidney transplantation in Europe: An ERA Registry study

Anneke Kramer (Lead / Corresponding author), Rianne Boenink, Cynthia G Mercado Vergara, Samira Bell, Julia Kerschbaum, Olga Lucía Rodríguez Arévalo, Auxiliadora Mazuecos, Aiko P J de Vries, Anna Varberg 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 ArnolMustafa Arici, Alberto Ortiz, Kitty J. Jager, Daniel Abramowicz, Vianda S. Stel, Rachel Hellemans

Research output: Contribution to journalArticlepeer-review


Background: Preemptive kidney transplantation has better outcomes when compared to transplantation after dialysis. We aimed to examine trends in preemptive kidney transplantation between 2000 and 2019 in Europe and to provide an overview of associated policies, barriers and initiatives.
Methods: Adult patients from 12 European countries who received a preemptive kidney transplant were included. The representatives of the registries providing these data were questioned on the policies, barriers and initiatives around preemptive kidney transplantation.
Results: Between 2000 and 2019, 20251 adults underwent preemptive kidney transplantation (11169 from living donors, 8937 from deceased donors). The proportion of first kidney transplantations that were preemptive more than doubled from 7% in 2000 to 18% in 2019, reflecting a similar relative increase for living donor kidney recipients (from 21% to 43%) and deceased donor kidney recipients (from 4% to 11%). Large international differences were found. The increase in preemptive kidney transplantation was observed across all age, sex and primary renal disease groups. Countries had similar criteria for preemptive waitlisting. Barriers mentioned included donor shortage, late referral to the transplant center and long donor or recipient work-up. Suggested initiatives included raising awareness on the possibility of preemptive kidney transplantation, earlier start and shorter work-up time for recipient and living donor.
Conclusions: Over the last two decades the proportion of patients receiving a first kidney transplant preemptively has more than doubled, reflecting a similar relative increase for living and deceased donor kidney recipients.
Original languageEnglish
Article numbergfae105
Number of pages27
JournalNephrology Dialysis Transplantation
Early online date9 May 2024
Publication statusE-pub ahead of print - 9 May 2024


  • preemptive kidney transplantation
  • barriers
  • trends
  • Europe


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