Chapter Chapter 27 - Recipient selection

Summary

The preoperative evaluation of kidney transplant candidates involves transplant surgeons, nephrologists, mental health professionals, social workers, dieticians, financial coordinators, and transplant coordinators. There are several absolute and relative contraindications to kidney transplantation. Immunologic evaluation begins with a thorough history of potential antigen exposure, including prior transplantation of any kind, blood product transfusion, and, in female candidates, prior pregnancy. Cardiovascular disease is the leading cause of death, and therefore graft loss, in the first year post transplant. Depending on the malignancy, a disease-free period of between 2 and 5 years is generally accepted as adequate. As the transplanted kidney usually drains into the native lower urinary tract, underlying urologic disease can affect the transplant outcome. In the future, diabetes management via islet cell transplantation, coupled with kidney transplantation, may be considered. A multi-disciplinary approach considering cognitive and other psychosocial factors is necessary to ensure successful transplantation.