Evaluation of the potential renal transplant recipient
- Ana P Rossi, MD, MPH
Ana P Rossi, MD, MPH
- Transplant Nephrologist, Maine Transplant Program
- Maine Medical Center
- Christina L Klein, MD
Christina L Klein, MD
- Transplant Nephrologist
- Piedmont Transplant Institute
- Section Editors
- Barbara Murphy, MB, BAO, BCh, FRCPI
Barbara Murphy, MB, BAO, BCh, FRCPI
- Section Editor — Renal Transplantation
- Professor of Medicine
- Mount Sinai School of Medicine
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
Kidney transplantation is the treatment of choice for most patients with end-stage renal disease (ESRD) [1,2]. A successful kidney transplant improves quality of life and reduces the mortality risk for the majority of patients when compared with maintenance dialysis.
Patients with ESRD often have significant comorbidities. It is important that potential kidney transplant recipients are carefully evaluated in order to detect and treat coexisting illnesses, which may affect perioperative risk and survival after transplantation, as well as transplant candidacy [3,4]. (See "Patient survival after renal transplantation".) The evaluation should be as efficient and cost effective as possible.
This topic will review the evaluation of a potential renal transplant recipient. The evaluation of the renal transplant donor is discussed separately. (See "Evaluation of the living kidney donor".)
Issues related to patient survival following transplantation, risk factors associated with graft failure, and the kidney transplant waitlist are discussed elsewhere. (See "Patient survival after renal transplantation" and "Risk factors for graft failure in kidney transplantation" and "The kidney transplant waiting list in the United States".)
TIMING OF TRANSPLANTATION REFERRAL
Transplantation should be discussed with all patients with irreversible and progressive chronic kidney disease (CKD).
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- TIMING OF TRANSPLANTATION REFERRAL
- INITIAL EVALUATION
- Absolute contraindications
- Relative contraindications
- - Systemic conditions
- Initial screening studies
- TARGETED EVALUATION FOR INDIVIDUAL PATIENTS
- Cardiovascular disease
- - Coronary heart disease
- - Heart failure
- Gastrointestinal disease
- Cerebrovascular disease
- Peripheral vascular disease
- Pulmonary disease
- Patients with a history of cancer
- Abnormal lower urinary tract
- Hematologic disorders
- Psychosocial issues
- Other special considerations
- - Retransplantation
- - Renal diagnosis
- NEPHRECTOMY PRIOR TO TRANSPLANTATION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS