To estimate the association of preemptive versus nonpreemptive kidney transplantation with mortality and graft outcomes while addressing selection and lead-time biases.
Approach:
Design: Observational target trial emulation using a US national transplant registry.
Population: Adults receiving a first kidney-alone transplant who were listed before dialysis and had a documented date when eGFR first reached 20 mL/min/1.73 m² or below, from 2005 through 2015.
Analysis: Left-truncated Cox models began follow-up at the eGFR threshold; inverse probability of treatment weighting was used to address baseline confounding. Preemptive transplantation was defined as transplantation without prior dialysis.
Outcomes: Primary outcome was all-cause mortality. Secondary outcomes were all-cause graft failure, death-censored graft failure, and delayed graft function.
Key Findings:
The supplied context describes the study rationale, cohort, methods, and outcomes but does not report the study’s results.
Interpretation:
The analysis was designed to estimate outcome associations among preemptively listed recipients who ultimately underwent transplantation; registry data did not capture intent to pursue preemptive transplantation.
Limitations:
The supplied context does not include study results or detailed limitations.
The observational registry design cannot establish causality.
The registry did not capture intent to pursue preemptive transplantation, so preemptive wait-listing served as a surrogate.
Breast cancer management is becoming increasingly biology-driven, with treatment decisions extending well beyond anatomic stage and conventional receptor classification.
