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Evaluation of Renal Transplant Candidates

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Core Concepts in Renal Transplantation

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Abstract

The pretransplant evaluation of kidney transplant candidates is a complex process which is best carried out in the context of a multidisciplinary approach. A given patient’s candidacy is determined not only by a careful assessment of the medical/surgical risks but also by a thorough determination of each individual’s psychosocial aspects. What follows is our attempt to provide the reader with a series of simple facts which we hope will, in turn, facilitate an understanding of this ­delicate process.

Kidney transplantation is the treatment of choice for most patients with end stage kidney disease (ESKD). There is ample evidence that transplantation is associated with a superior quality and length of life at a lower economic cost. Therefore, appropriate selection of transplant candidates is one of the most important goals of a transplant team. There have been several sets of guidelines produced by experts in the transplantation field to guide the appropriate and timely evaluation of these patients. The goal pretransplant evaluation is to determine that the necessary medical, surgical, and psychosocial conditions are met to derive a maximal benefit from transplantation.

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References

  1. Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725–30.

    Article  PubMed  CAS  Google Scholar 

  2. Kasiske BL, Ramos EL, Gaston RS, et al. The evaluation of renal transplant candidates: clinical practice guidelines. Patient Care and Education Committee of the American Society of Transplant Physicians. J Am Soc Nephrol. 1995;6:1–34.

    PubMed  CAS  Google Scholar 

  3. Steinman TI, Becker BN, Frost AE, et al. Guidelines for the referral and management of patients eligible for solid organ transplantation. Transplantation. 2001;71:1189–204.

    Article  PubMed  CAS  Google Scholar 

  4. Kasiske BL, Cangro CB, Hariharan S, et al. The evaluation of renal transplantation candidates: clinical practice guidelines. Am J Transplant. 2001;1 Suppl 2:3–95.

    PubMed  Google Scholar 

  5. Knoll G, Cockfield S, Blydt-Hansen T, et al. Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation. CMAJ. 2005;173:S1–25.

    Article  PubMed  Google Scholar 

  6. Goldfarb-Rumyantzev A, Hurdle JF, Scandling J, et al. Duration of end-stage renal disease and kidney transplant outcome. Nephrol Dial Transplant. 2005;20:167–75.

    Article  PubMed  Google Scholar 

  7. Gaston RS, Danovitch GM, Adams PL, et al. The report of a national conference on the wait list for kidney transplantation. Am J Transplant. 2003;3:775–85.

    Article  PubMed  Google Scholar 

  8. Kiberd B, Boudreault J, Bhan V, Panek R. Access to the kidney transplant wait list. Am J Transplant. 2006;6:2714–20.

    Article  PubMed  CAS  Google Scholar 

  9. Lentine KL, Brennan DC, Schnitzler MA. Incidence and predictors of myocardial infarction after kidney transplantation. J Am Soc Nephrol. 2005;16:496–506.

    Article  PubMed  Google Scholar 

  10. Lentine KL, Schnitzler MA, Abbott KC, et al. De novo congestive heart failure after kidney transplantation: a common condition with poor prognostic implications. Am J Kidney Dis. 2005;46:720–33.

    Article  PubMed  Google Scholar 

  11. Lentine KL, Schnitzler MA, Abbott KC, et al. Incidence, predictors, and associated outcomes of atrial fibrillation after kidney transplantation. Clin J Am Soc Nephrol. 2006;1:288–96.

    Article  PubMed  Google Scholar 

  12. Kasiske BL, Maclean JR, Snyder JJ. Acute myocardial infarction and kidney transplantation. J Am Soc Nephrol. 2006;17:900–7.

    Article  PubMed  Google Scholar 

  13. Sharma R, Pellerin D, Gaze DC, et al. Dobutamine stress echocardiography and the resting but not exercise electrocardiograph predict severe coronary artery disease in renal transplant candidates. Nephrol Dial Transplant. 2005;20:2207–14.

    Article  PubMed  Google Scholar 

  14. De Lima JJ, Sabbaga E, Vieira ML, et al. Coronary angiography is the best predictor of events in renal transplant candidates compared with noninvasive testing. Hypertension. 2003;42:263–8.

    Article  PubMed  Google Scholar 

  15. Charytan D, Kuntz RE, Mauri L, DeFilippi C. Distribution of coronary artery disease and relation to mortality in asymptomatic hemodialysis patients. Am J Kidney Dis. 2007;49:409–16.

    Article  PubMed  Google Scholar 

  16. Gowdak LH, de Paula FJ, Cesar LA, et al. Diabetes and coronary artery disease impose similar cardiovascular morbidity and mortality on renal transplant candidates. Nephrol Dial Transplant. 2007;22:1456–61.

    Article  PubMed  Google Scholar 

  17. Gowdak LH, de Paula FJ, Cesar LA, et al. Screening for significant coronary artery disease in high-risk renal transplant candidates. Coron Artery Dis. 2007;18:553–8.

    Article  PubMed  Google Scholar 

  18. Patel RK, Mark PB, Johnston N, et al. Prognostic value of cardiovascular screening in potential renal transplant recipients: a single-center prospective observational study. Am J Transplant. 2008;8:1673–83.

    Article  PubMed  CAS  Google Scholar 

  19. EBPG Expert Group on Renal Transplantation. European best practice guidelines for renal transplantation. Section IV: long-term management of the transplant recipient. IV.5.1. Cardiovascular risks. Cardiovascular disease after renal transplantation. Nephrol Dial Transplant. 2002;17(Suppl 4):24–5.

    Google Scholar 

  20. K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45:S1–153.

    Google Scholar 

  21. Klocke FJ, Baird MG, Lorell BH, et al. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging – executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging). J Am Coll Cardiol. 2003;42:1318–33.

    Article  PubMed  Google Scholar 

  22. Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography – summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Coll Cardiol. 2003;42:954–70.

    Article  PubMed  Google Scholar 

  23. Koistinen MJ, Huikuri HV, Pirttiaho H, Linnaluoto MK, Takkunen JT. Evaluation of exercise electrocardiography and thallium tomographic imaging in detecting asymptomatic coronary artery disease in diabetic patients. Br Heart J. 1990;63:7–11.

    Article  PubMed  CAS  Google Scholar 

  24. Marwick TH, Steinmuller DR, Underwood DA, et al. Ineffectiveness of dipyridamole SPECT thallium imaging as a screening technique for coronary artery disease in patients with end-stage renal failure. Transplantation. 1990;49:100–3.

    Article  PubMed  CAS  Google Scholar 

  25. Dahan M, Viron BM, Faraggi M, et al. Diagnostic accuracy and prognostic value of combined dipyridamole-exercise thallium imaging in hemodialysis patients. Kidney Int. 1998;54:255–62.

    Article  PubMed  CAS  Google Scholar 

  26. Schmidt A, Stefenelli T, Schuster E, Mayer G. Informational contribution of noninvasive screening tests for coronary artery disease in patients on chronic renal replacement therapy. Am J Kidney Dis. 2001;37:56–63.

    Article  PubMed  CAS  Google Scholar 

  27. Reis G, Marcovitz PA, Leichtman AB, et al. Usefulness of dobutamine stress echocardiography in detecting coronary artery disease in end-stage renal disease. Am J Cardiol. 1995;75:707–10.

    Article  PubMed  CAS  Google Scholar 

  28. Bates JR, Sawada SG, Segar DS, et al. Evaluation using dobutamine stress echocardiography in patients with insulin-dependent diabetes mellitus before kidney and/or pancreas transplantation. Am J Cardiol. 1996;77:175–9.

    Article  PubMed  CAS  Google Scholar 

  29. Herzog CA, Marwick TH, Pheley AM, White CW, Rao VK, Dick CD. Dobutamine stress echocardiography for the detection of significant coronary artery disease in renal transplant candidates. Am J Kidney Dis. 1999;33:1080–90.

    Article  PubMed  CAS  Google Scholar 

  30. Budoff MJ, Shaw LJ, Liu ST, et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007;49:1860–70.

    Article  PubMed  Google Scholar 

  31. Goodman WG, Goldin J, Kuizon BD, et al. Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis. N Engl J Med. 2000;342:1478–83.

    Article  PubMed  CAS  Google Scholar 

  32. Herzog CA, Ma JZ, Collins AJ. Long-term outcome of renal transplant recipients in the United States after coronary revascularization procedures. Circulation. 2004;109:2866–71.

    Article  PubMed  Google Scholar 

  33. McFalls EO, Ward HB, Moritz TE, et al. Coronary-artery revascularization before elective major vascular surgery. N Engl J Med. 2004;351:2795–804.

    Article  PubMed  CAS  Google Scholar 

  34. Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.

    Article  PubMed  CAS  Google Scholar 

  35. Manske CL, Wang Y, Rector T, Wilson RF, White CW. Coronary revascularisation in insulin-dependent diabetic patients with chronic renal failure. Lancet. 1992;340:998–1002.

    Article  PubMed  CAS  Google Scholar 

  36. Patel AD, Abo-Auda WS, Davis JM, et al. Prognostic value of myocardial perfusion imaging in predicting outcome after renal transplantation. Am J Cardiol. 2003;92:146–51.

    Article  PubMed  Google Scholar 

  37. Kasiske BL, Malik MA, Herzog CA. Risk-stratified screening for ischemic heart disease in kidney transplant candidates. Transplantation. 2005;80:815–20.

    Article  PubMed  Google Scholar 

  38. Lewis MS, Wilson RA, Walker K, et al. Factors in cardiac risk stratification of candidates for renal transplant. J Cardiovasc Risk. 1999;6:251–5.

    PubMed  CAS  Google Scholar 

  39. Eagle KA, Berger PB, Calkins H, et al. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery – Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). Anesth Analg. 2002;94:1052–64.

    Article  PubMed  Google Scholar 

  40. Gill JS, Ma I, Landsberg D, Johnson N, Levin A. Cardiovascular events and investigation in patients who are awaiting cadaveric kidney transplantation. J Am Soc Nephrol. 2005;16:808–16.

    Article  PubMed  Google Scholar 

  41. Siedlecki A, Foushee M, Curtis JJ, et al. The impact of left ventricular systolic dysfunction on survival after renal transplantation. Transplantation. 2007;84:1610–7.

    Article  PubMed  Google Scholar 

  42. de Mattos AM, Siedlecki A, Gaston RS, et al. Systolic dysfunction portends increased mortality among those waiting for renal transplant. J Am Soc Nephrol. 2008;19:1191–6.

    Article  PubMed  Google Scholar 

  43. Burt RK, Gupta-Burt S, Suki WN, Barcenas CG, Ferguson JJ, Van Buren CT. Reversal of left ventricular dysfunction after renal transplantation. Ann Intern Med. 1989;111:635–40.

    PubMed  CAS  Google Scholar 

  44. Sung RS, Althoen M, Howell TA, Merion RM. Peripheral vascular occlusive disease in renal transplant recipients: risk factors and impact on kidney allograft survival. Transplantation. 2000;70:1049–54.

    Article  PubMed  CAS  Google Scholar 

  45. Makisalo H, Lepantalo M, Halme L, et al. Peripheral arterial disease as a predictor of outcome after renal transplantation. Transpl Int. 1998;11 Suppl 1:S140–3.

    Article  PubMed  Google Scholar 

  46. Oliveras A, Roquer J, Puig JM, et al. Stroke in renal transplant recipients: epidemiology, predictive risk factors and outcome. Clin Transplant. 2003;17:1–8.

    Article  PubMed  Google Scholar 

  47. Ong AC. Screening for intracranial aneurysms in ADPKD. BMJ. 2009;339:b3763.

    Article  PubMed  Google Scholar 

  48. Kasiske BL, Klinger D. Cigarette smoking in renal transplant recipients. J Am Soc Nephrol. 2000;11:753–9.

    PubMed  CAS  Google Scholar 

  49. Rao PS, Merion RM, Ashby VB, Port FK, Wolfe RA, Kayler LK. Renal transplantation in elderly patients older than 70 years of age: results from the Scientific Registry of Transplant Recipients. Transplantation. 2007;83:1069–74.

    Article  PubMed  Google Scholar 

  50. Biesenbach G, Konigsrainer A, Gross C, Margreiter R. Progression of macrovascular diseases is reduced in type 1 diabetic patients after more than 5 years successful combined pancreas-kidney transplantation in comparison to kidney transplantation alone. Transpl Int. 2005;18:1054–60.

    Article  PubMed  CAS  Google Scholar 

  51. Reddy KS, Stablein D, Taranto S, et al. Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure. Am J Kidney Dis. 2003;41:464–70.

    Article  PubMed  Google Scholar 

  52. Heher EC, Spitzer TR, Goes NB. Light chains: heavy burden in kidney transplantation. Transplantation. 2009;87:947–52.

    Article  PubMed  Google Scholar 

  53. Spitzer TR, Sykes M, Tolkoff-Rubin N, et al. Long-term follow-up of recipients of combined human leukocyte antigen-matched bone marrow and kidney transplantation for multiple myeloma with end-stage renal disease. Transplantation 2011;91:672–6.

    Article  PubMed  CAS  Google Scholar 

  54. Rostaing L, Modesto A, Abbal M, Durand D. Long-term follow-up of monoclonal gammopathy of undetermined significance in transplant patients. Am J Nephrol. 1994;14:187–91.

    Article  PubMed  CAS  Google Scholar 

  55. Nguyen DH, Reinberg Y, Gonzalez R, Fryd D, Najarian JS. Outcome of renal transplantation after urinary diversion and enterocystoplasty: a retrospective, controlled study. J Urol. 1990;144:1349–51.

    PubMed  CAS  Google Scholar 

  56. Landin L, Rodriguez-Perez JC, Garcia-Bello MA, et al. Kidney transplants in HIV-positive recipients under HAART. A comprehensive review and meta-analysis of 12 series. Nephrol Dial Transplant. 2010;25:3106–15.

    Article  PubMed  CAS  Google Scholar 

  57. Dharnidharka VR, Cherikh WS, Neff R, Cheng Y, Abbott KC. Retransplantation after BK virus nephropathy in prior kidney transplant: an OPTN database analysis. Am J Transplant. 2010;10:1312–5.

    Article  PubMed  CAS  Google Scholar 

  58. Eason JD, Gonwa TA, Davis CL, Sung RS, Gerber D, Bloom RD. Proceedings of consensus conference on simultaneous liver kidney transplantation (SLK). Am J Transplant. 2008;8:2243–51.

    Article  PubMed  CAS  Google Scholar 

  59. Fabrizi F, Martin P, Dixit V, Kanwal F, Dulai G. HBsAg seropositive status and survival after renal transplantation: meta-analysis of observational studies. Am J Transplant. 2005;5:2913–21.

    Article  PubMed  CAS  Google Scholar 

  60. Kidney Disease: Improving Global Outcomes (KDIGO ).KDIGO clinical practice guidelines for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl. 2008;(109):S1–99.

    Google Scholar 

  61. Mignani R, Feriozzi S, Schaefer RM, et al. Dialysis and transplantation in Fabry disease: indications for enzyme replacement therapy. Clin J Am Soc Nephrol. 2010;5:379–85.

    Article  PubMed  Google Scholar 

  62. Modanlou KA, Muthyala U, Xiao H, et al. Bariatric surgery among kidney transplant candidates and recipients: analysis of the United States renal data system and literature review. Transplantation. 2009;87:1167–73.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Renal Division, Brigham and Women’s Hospital, Boston, MA, USA

    Martina M. McGrath MB, BAO, BCh

  2. Massachusetts General Hospital, 165 Cambridge St., Suite 302, Boston, MA, 02114, USA

    Mario F. Rubin MD

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  1. Martina M. McGrath MB, BAO, BCh
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Correspondence to Mario F. Rubin MD .

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Editors and Affiliations

  1. Harvard Medical School, Renal Division, Brigham and Women's Hospital, Francis Street 75, Boston, 02115, Massachusetts, USA

    Anil Chandraker

  2. Harvard Medical School, Renal Division, Brigham and Women's Hospital, Francis Street 75, Boston, 02115, Massachusetts, USA

    Mohamed H. Sayegh

  3. Harvard Medical School, Renal Division, Brigham and Women's Hospital, Francis Street 75, Boston, 02115, Massachusetts, USA

    Ajay K. Singh

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McGrath, M.M., Rubin, M.F. (2012). Evaluation of Renal Transplant Candidates. In: Chandraker, A., Sayegh, M., Singh, A. (eds) Core Concepts in Renal Transplantation. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-0008-0_4

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  • DOI: https://doi.org/10.1007/978-1-4614-0008-0_4

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