Child holding a glowing kidney, representing hope and health after kidney transplant

Kidney Transplants: Are Pre-emptive Procedures Safer for Children?

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Lena Voss in Health & Wellness December 2025 • 4 min read.

"A new study dives into surgical complications in pediatric kidney transplants, comparing outcomes for children who receive pre-emptive transplants versus those who undergo dialysis first."


For children facing end-stage renal disease (ESRD), a kidney transplant offers a chance at a healthier, more fulfilling life. Unlike dialysis, which requires ongoing treatments and can impact quality of life, a successful transplant can restore kidney function and improve overall well-being. But with any major surgery, complications can arise. This raises an important question: Is there a way to minimize these risks, particularly for our youngest patients?

One approach gaining traction is pre-emptive kidney transplantation. This involves performing the transplant before dialysis becomes necessary. The idea is that avoiding dialysis and its associated side effects might lead to better outcomes. However, the full picture of how pre-emptive transplants compare to those done after dialysis, especially concerning surgical complications, hasn't been entirely clear.

A new study published in the journal Clinical Transplantation aimed to shed light on this very issue. Researchers conducted a thorough review of pediatric kidney transplant cases, comparing the surgical complication rates between children who received pre-emptive transplants and those who underwent transplantation after starting dialysis. Their findings offer valuable insights for families and medical professionals alike.

Pre-emptive vs. Post-Dialysis: What the Study Examined

Child holding a glowing kidney, representing hope and health after kidney transplant

The study, conducted at a single institution from 2000 to 2015, retrospectively reviewed kidney transplantations in children. The researchers analyzed data from 318 patients, dividing them into four groups based on donor type (deceased donor [DD] or living donor [LD]) and whether the transplant was pre-emptive or post-dialysis:

The main goal was to compare intra- and post-operative complication rates and one-year graft survival among these groups. The researchers meticulously collected data on various factors, including:

  • Patient demographics (age, sex, height, weight)
  • Cause of ESRD
  • Surgical details (surgeon, operative time, type of anastomosis)
  • Intra- and post-operative complications (classified using the Clavien-Dindo grading system)
  • Graft loss
By analyzing this data, the researchers hoped to determine if pre-emptive kidney transplantation offered a significant advantage in reducing surgical complications in the pediatric population.

The Bottom Line: Weighing the Options for Pediatric Kidney Transplants

The study's findings provide valuable information for families and healthcare providers considering kidney transplantation for children with ESRD. While pre-emptive transplantation may offer some benefits in specific cases, the decision ultimately requires careful consideration of individual patient factors, potential risks and benefits, and the availability of suitable donor organs. Further research is needed to refine our understanding of the long-term outcomes associated with different transplantation approaches and to identify strategies for minimizing complications and improving the lives of young transplant recipients.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/ctr.13421, Alternate LINK

Title: Assessment Of Perioperative Surgical Complications In Pediatric Kidney Transplantation: A Comparison Of Pre-Emptive And Post-Dialysis Recipients

Subject: Transplantation

Journal: Clinical Transplantation

Publisher: Wiley

Authors: Jin K. Kim, Armando J. Lorenzo, Walid A. Farhat, Michael E. Chua, Jessica M. Ming, Martin A. Koyle

Published: 2018-10-26

Everything You Need To Know

1

What is a pre-emptive kidney transplant?

A pre-emptive kidney transplant involves performing a kidney transplant before dialysis becomes necessary for children facing end-stage renal disease (ESRD). This approach aims to avoid the complications associated with dialysis, which include ongoing treatments and potential impacts on the quality of life. The main idea is to improve patient outcomes by avoiding dialysis and its related side effects.

2

What was the main goal of the study?

The study compared the surgical complication rates between children who received pre-emptive transplants and those who underwent transplantation after starting dialysis. The study looked at a cohort of 318 patients, divided into four groups based on donor type (deceased donor [DD] or living donor [LD]) and whether the transplant was pre-emptive or post-dialysis. It assessed intra- and post-operative complication rates, and one-year graft survival. It examined patient demographics, cause of ESRD, surgical details, intra- and post-operative complications, and graft loss.

3

What is End-Stage Renal Disease (ESRD) and why is it relevant?

ESRD, or End-Stage Renal Disease, is a condition where the kidneys are no longer able to function adequately, which can lead to a patient needing a kidney transplant to help them. Without proper kidney function the body cannot remove waste products. Dialysis is one treatment option, while a successful kidney transplant can restore kidney function and improve overall well-being.

4

What is the Clavien-Dindo grading system?

The Clavien-Dindo grading system is used to classify the severity of surgical complications. The researchers utilized this system to assess the intra- and post-operative complications in the study. The system helps in standardizing the assessment of complications.

5

Why are the study's findings significant?

The findings from the study are important for families and healthcare providers because they provide important information when considering kidney transplantation for children with ESRD. While pre-emptive transplantation may offer some benefits in specific cases, the decision ultimately requires careful consideration of individual patient factors, potential risks and benefits, and the availability of suitable donor organs.

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