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Pre-emptive Transplant Diabetic CKD — ESENeph MCQ

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EasyTransplantationPre-emptive Transplant Diabetic CKDESENeph

A 30-year-old woman with type 1 diabetes and CKD G4 is being evaluated for transplant. She has significant cardiovascular risk. Is pre-emptive kidney transplant still recommended?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Yes – pre-emptive transplant (before dialysis) provides the best outcomes regardless of diabetes status; time on dialysis is independently associated with worse graft and patient survival

Pre-emptive kidney transplantation (performed before the need for dialysis) consistently shows the best patient and graft survival outcomes compared to transplant after dialysis initiation. This applies to both diabetic and non-diabetic patients. Each year on dialysis before transplant incrementally worsens post-transplant outcomes. NICE NG107 and KDIGO 2020 recommend that transplant evaluation should begin when eGFR approaches 15-20 mL/min/1.73m2, allowing time for living donor workup or deceased donor listing before dialysis is needed.

Reference: NICE NG107 2018 – RRT; Meier-Kriesche et al 2000 – Pre-emptive Transplant Survival