How to Prepare a Chronic Kidney Disease Patient for Transplantation
Transplantation is the optimal treatment modality for patients with end-stage renal disease (ESRD). Compared to dialysis treatments, renal transplantation provides better survival and quality of life and decreases the cost of medical care. Preparation of the patient with chronic kidney disease (CKD) for transplantation should begin well before initiation of dialysis. Preemptive (before dialysis) transplantation may be applied, if a living donor is available. Even if living donation is not a possible option, the patient can be listed for cadaveric renal transplantation immediately after dialysis started. Preparing a patient with CKD for transplantation involves careful evaluation for contraindications of transplantation and inherent risks and potential medical and surgical complications. During evaluation, findings obtained from a systematic clinical history and examination and a number of routine tests must be gathered to exclude or correct disorders that comprise a contraindication to transplantation or which may have impact on the course of the patient. However, complex medical issues broadly defined non-standardized criteria and differences in guideline recommendations cause a challenge for selection and preparation of appropriate transplant candidate. Despite the controversy, a common approach recommends that each patient must be assessed on an individualized basis and the choice of treatment modality is to be determined in the consensus of a multidisciplinary team. This chapter describes a practical approach for the evaluation of a potential renal transplant candidate. General contraindications to transplant and various medical issues that arise during the preparation process are discussed.
KeywordsObesity Hepatitis Filtration Depression Ischemia
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