Indications and Contraindications

Kidney Transplant Program

Potential Indications for Kidney Transplantation

With the tremendous improvements in transplant management most patients with kidney failure can be considered for transplantation. Diseases that may be indications for renal transplantation are listed below:

Glomerulonephritis

  • Idiopathic and postinfectious crescentic

  • Membranous

  • Mesangiocapillary (Type I)

  • Mesangiocapillary (Type II) (dense-deposit disease)

  • IgA nephropathy

  • Antiglomerular basement membrane

  • Focal glomerulosclerosis

  • Henoch-Schonlein

  • Chronic pyelonephritis (reflux nephropathy)

    Hereditary

  • Polycystic kidneys

  • Nephronophthisis (medullary cystic disease)

  • Nephritis (including Alport's syndrome)

  • Tuberous sclerosis

  • Metabolic

  • Diabetes mellitus

  • Hyperoxaluria

  • Cystinosis

  • Fabry's disease

  • Amyloid

  • Gout

  • Porphyria

  • Obstructive nephropathy

    Toxic

  • Analgesic nephropathy

  • Opiate abuse

  • Multisystem Diseases

  • Systemic lupus erythematosus

  • Vasculitis

  • Progressive systemic sclerosis

  • Haemolytic uraemic syndrome

    Tumors

  • Wilms' tumor

  • Renal cell carcinoma

  • Incidental carcinoma

  • Myeloma

  • Congenital

  • Hypoplasia

  • Horseshoe kidney

  • Irreversible Acute Renal Failure

  • Cortical necrosis

  • Acute tubular necrosis

  • Trauma

    We consider patients between the ages of two and 70 who require dialysis, or expect to require dialysis within the next 12 months. We usually can satisfactorily resolve other medical problems to increase the safety of a transplant. Patients may be evaluated prior to dialysis to discuss options for renal replacement therapy. This is particularly valuable since living donor kidney transplantation can be considered and timed appropriately to serve as renal replacement therapy preventing the need for costly dialysis access surgery.

    All causes for kidney failure can be considered for transplantation. However, the cause of kidney failure may have an effect on the outcome of kidney transplantation. Some causes of kidney failure such as certain types of glomerulonephritis may occasionally recur in the new transplant. In most cases, transplantation is worthwhile since recurrence is usually very slow to develop. These risks are discussed with patients on a case-by-case basis. Patients with primary oxalosis require combined kidney-liver transplantation since without metabolic correction of oxalosis with liver transplantation, recurrent kidney disease would be very rapid.

    Causes of ESRD may recur in a transplanted kidney. Recurrence is usually quite slow. Recurrent disease is rarely seen before the second decade.

    Diseases which may recur in renal transplants are listed below:

    • IgA nephropathy
    • focal segmental glomerulosclerosis
    • membranous glomerulonephritis
    • membranoproliferative glomerulonephritis
    • amyloidosis
    • cystinosis


    Contraindications for Kidney Transplantation

    There are certain absolute contraindications to renal transplantation:

  • Disseminated or untreated cancer

  • Severe psychiatric disease

  • Unresolvable psychosocial problems

  • Persistent substance abuse

  • Severe mental retardation

  • Un-reconstructable coronary artery disease or refractory congestive heart failure

  • Relative contraindications:

  • Treated malignancy. The cancer-free interval required will vary depending on the stage and type of cancer. Consultation with a board-certified oncologist is required in most cases.

  • Substance abuse history. Patients must present evidence of involvement in at least 12 months of drug-free rehabilitation. This includes written documentation of participation in rehabilitation including negative random toxicologic screens.

  • Chronic liver disease. Candidates with chronic hepatitis B or C or persistently abnormal liver function testing must have hepatology consultation prior to transplantation.

  • Cardiac disease. All patients over the age of 55 or those with a history of diabetes, hypertension, or tobacco abuse must have dobutamine stress echocardiography, or exercise or pharmacologic stress cardiac scintigraphy. Any patient with a history of a positive stress test or history of congestive heart failure must have cardiology evaluation prior to transplantation.

  • Structural genitourinary abnormality or recurrent urinary tract infection. Urologic consultation is required prior to transplantation.

  • Past psychosocial abnormality. Master of Social Work (MSW) or psychiatry evaluation, as appropriate.

  • Aortoiliac disease. Patients with abnormal femoral pulses or disabling claudication, rest pain or gangrene will require evaluation by a board certified vascular surgeon prior to consideration. Patients with significant aortoiliac occlusive disease may require angioplasty or aortoiliac grafting prior to transplantation.

  • This page was last updated: April 24, 2013

             
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