This occurred when all of the following find more criteria were met: recipient age 18–59 years, deceased donor age less than live donor age, and deceased donor HLA match better than live donor HLA match. The impact of waiting on dialysis was not taken into account in this analysis. The impact of waiting time on the success of transplantation has been examined in several studies. Meier-Kriesche et al. analyzed United States Renal Data System (USRDS) data from 73 103 primary adult renal transplants performed between 1988 and 1997.7 There was a progressive rise in the risk of

death and death-censored graft loss with increasing time on dialysis prior to transplantation. The increases in mortality risk for waiting relative to pre-emptive transplantation were as follows: 6–12 month wait, 21%; 12–24 month wait, 28%; 24–36 month wait, 41%; 36–48 month wait, 53%; and >48 month wait, 72%. In another publication, Meier-Kriesche and Kaplan reported that waiting for a live donor transplant for more than 2 years while on dialysis reduced

graft survival to the same level as that for deceased CP-690550 donor transplants performed within 6 months of commencing dialysis.8 Using UNOS Registry data, Gjertson reported that pre-transplant dialysis time accounted for 12–13% of the variation seen in 1-year graft survival rates for both live and deceased donor transplantation.9 Also using UNOS Registry data, Kasiske et al. reported that the relative risk of death or graft failure, was lower in deceased donor and live donor recipients who were transplanted pre-emptively, compared with those transplanted following commencement of dialysis.10 Racial minority groups and those with a lower level of education were less likely to be transplanted pre-emptively. With regards to recipients who are less than 18 years old, a study by Ishitani et al. examined the success of live, related donor transplantation in paediatric recipients using UNOS Registry data.11 When compared with pre-emptive

transplantation, there was a relative risk of graft failure of 1.77 in those transplanted after dialysis had commenced. Kennedy et al. used ANZDATA to examine graft outcomes in transplanted adolescents, and also reported improved outcomes with pre-emptive transplantation.12 Wolfe et al. compared the survival Methane monooxygenase of those on the waiting list with those for individuals receiving a primary deceased donor transplant.13 Standardized mortality ratios were derived from an analysis of 228 552 subjects on dialysis. A total of 46 164 individuals were on the waiting list, of whom 23 275 received a primary deceased donor transplant over a 7-year period of observation. The annual death rate for those on the waiting list was 6.3 per 100 patient-years. By comparison, those transplanted had a long-term annual death rate of 3.8 per 100 patient-years. The improvement in relative risk of mortality was most pronounced for young, white recipients (20–39 years) and for people with diabetes.