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Assessment of the Potential Transplant Recipient

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Abstract

Renal transplantation is now a routine procedure with, for example, over 23,000 kidney transplants a year in the USA and 3000 a year in the UK, which brings significant benefits in terms of patient survival, quality of life improvement, and healthcare savings. However, kidneys remain a scarce resource and acutely renal transplantation is a physically (and emotionally) challenging procedure. Premature graft loss, infections, malignancy, recurrent disease, cardiovascular events, and death are all well-recognized complications that need to be discussed, risk assessed, and mitigated.

While it is relatively straightforward to activate a fit, healthy 30-year-old with single organ failure awaiting the first transplant, the risk benefits become much more nuanced and challenging for patients of increasing age and co-morbidity. Therefore, assessment of potential transplants needs a clear process and governance to avoid (a) unsuitable candidates being called in for transplantation, (b) patients who might, with the right workup and input be eligible for transplantation, be denied this, and (c) a workup process that is inefficient and delays listing of appropriate patients. Nephrologists and transplant surgeons also need to ensure that patients are assessed and activated for transplant in a timely fashion and similarly that marginal recipients are reviewed frequently and removed from the list if it is no longer appropriate. Recipient assessment is a complex but important area of practice.

This chapter covers the key aspects of medical and surgical screening and suggests structures for an assessment pathway.

We would like to dedicate a special thank you to Dr Albert Power and Dr Peter Dupont for their significant contribution to the first edition of this chapter.

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References

  1. Wong G, Howard K, Chapman JR, Chadban S, Cross N, Tong A, Webster AC, Craig JC. Comparative survival and economic benefits of deceased donor kidney transplantation and dialysis in people with varying ages and co-morbidities. PLoS One. 2012. https://doi.org/10.1371/journal.pone.0029591.

  2. Chris Dudley PH. Assessment of the potential kidney transplant recipient. Ren. Assoc. 2011.

    Google Scholar 

  3. European Renal Best Practice Transplantation Guideline Development Group. ERBP guideline on the management and evaluation of the kidney donor and recipient. Nephrol Dial Transplant. 2013.

    Google Scholar 

  4. Chadban SJ, Ahn C, Axelrod DA, et al. KDIGO clinical practice guideline on the evaluation and management of candidates for kidney transplantation. Transplantation. 2020. https://doi.org/10.1097/TP.0000000000003136.

  5. Campbell S, Pilmore H, Gracey D, Mulley W, Russell C, McTaggart S. KHA-cari guideline: recipient assessment for transplantation. Nephrology. 2013. https://doi.org/10.1111/nep.12068.

  6. NHS Blood and Transplant. Annual Report On Kidney Transplantation - Report For 2018/2019. 2019.

    Google Scholar 

  7. Taylor DM, Bradley JA, Bradley C, et al. Limited health literacy is associated with reduced access to kidney transplantation. Kidney Int. 2019. https://doi.org/10.1016/j.kint.2018.12.021.

  8. Rijkse E, van Dam JL, Roodnat JI, Kimenai HJAN, IJzermans JNM, Minnee RC. The prognosis of kidney transplant recipients with aorto-iliac calcification: a systematic review and meta-analysis. Transpl Int. 2020. https://doi.org/10.1111/tri.13592.

  9. Shishehbor MH, Aksut B, Poggio E, Flechner SM. Presence of peripheral artery disease in renal transplant outcomes - Don’t throw the baby out with the bath water. Vasc Med. 2017. https://doi.org/10.1177/1358863X17703195.

  10. Erwin PA, Goel SS, Gebreselassie S, Shishehbor MH. Restoration of renal allograft function: Via reduced-contrast percutaneous revascularization of transplant renal artery stenosis. Tex Heart Inst J. 2015. https://doi.org/10.14503/THIJ-13-4059.

  11. Davins M, Llagostera S, Jimenez R, Rosales A, Romero JM, Diaz M. Aortofemoral bypass to bridge end-stage renal disease patients with severe iliac calcification to kidney transplantation. Vascular. 2009. https://doi.org/10.2310/6670.2009.00044.

  12. Currie IC, Wilson YG, Baird RN, Lamont PM. Detection of sub-critical arterial stenoses by hyperaemic Doppler. Eur J Vasc Endovasc Surg. 1996. https://doi.org/10.1016/S1078-5884(96)80131-6.

  13. AbuRahma AF, Jarrett K, Hayes JD. Clinical implications of power Doppler three-dimensional ultrasonography. Vascular. 2004. https://doi.org/10.1258/rsmvasc.12.5.293.

  14. Brekke IB, Lien B, Sødal G, Jakobsen A, Bentdal, PP, Flatmark A, Fauchald P. Aortoiliac reconstruction in preparation for renal transplantation. Transpl Int. 1993. https://doi.org/10.1007/BF00336361.

  15. Hill CJ, Courtney AE, Cardwell CR, et al. Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis. Nephrol Dial Transplant. 2015. https://doi.org/10.1093/ndt/gfv214.

  16. Bardonnaud N, Pillot P, Lillaz J, Delorme G, Chabannes E, Bernardini S, Guichard G, Bittard H, Kleinclauss F. Outcomes of renal transplantation in obese recipients. Transplant Proc. 2012. https://doi.org/10.1016/j.transproceed.2012.09.031.

  17. Awan AA, Niu J, Pan JS, Erickson KF, Mandayam S, Winkelmayer WC, Navaneethan SD, Ramanathan V Trends in the causes of death among kidney transplant recipients in the United States (1996-2014). Am J Nephrol. 2018. https://doi.org/10.1159/000495081.

  18. Steenkamp R, Pyart R, Fraser S. UK renal registry 20th annual report: Chapter 5 survival and cause of death in UK adult patients on renal replacement therapy in 2016: National and centre-specific analyses. Nephron. 2018. https://doi.org/10.1159/000490963.

  19. Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol. 1998. https://doi.org/10.1016/s0021-9150(00)81051-5.

  20. USRDS (United States Renal Data System). 2018 annual data report – Chapter 4: Cardiovascular disease in patients with CKD. 2018.

    Google Scholar 

  21. Manske CL, Wang Y, Rector T, Wilson RF, White CW. Coronary revascularisation in insulin-dependent diabetic patients with chronic renal failure. Lancet. 1992. https://doi.org/10.1016/0140-6736(92)93010-K.

  22. Wang LW, Fahim MA, Hayen A, Mitchell RL, Lord SW, Baines LA, Craig JC, Webster AC. Cardiac testing for coronary artery disease in potential kidney transplant recipients: a systematic review of test accuracy studies. Am J Kidney Dis. 2011. https://doi.org/10.1053/j.ajkd.2010.11.018.

  23. Bangalore S, Maron DJ, O’Brien SM, et al. Management of coronary disease in patients with advanced kidney disease. N Engl J Med. 2020. https://doi.org/10.1056/NEJMoa1915925.

  24. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, et al. 2014 ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesth. Eur Heart J. 2014;35:2383–431.

    Article  Google Scholar 

  25. Wali RK, Wang GS, Gottlieb SS, et al. Effect of kidney transplantation on left ventricular systolic dysfunction and congestive heart failure in patients with end-stage renal disease. J Am Coll Cardiol. 2005. https://doi.org/10.1016/j.jacc.2004.11.061.

  26. Ricotta JJ, Aburahma A, Ascher E, Eskandari M, Faries P, Lal BK. Updated society for vascular surgery guidelines for management of extracranial carotid disease. J Vasc Surg. 2011. https://doi.org/10.1016/j.jvs.2011.07.031.

  27. Canaud G, Zuber J, Sberro R, et al. Intensive and prolonged treatment of focal and segmental glomerulosclerosis recurrence in adult kidney transplant recipients: a pilot study. Am J Transplant. 2009. https://doi.org/10.1111/j.1600-6143.2009.02580.x.

  28. Hickson LJ, Gera M, Amer H, et al. Kidney transplantation for primary focal segmental glomerulosclerosis: outcomes and response to therapy for recurrence. Transplantation. 2009. https://doi.org/10.1097/TP.0b013e31819f12be.

  29. Uffing A, Pérez-Sáez MJ, Mazzali M, et al. Recurrence of FSGS after kidney transplantation in adults. Clin J Am Soc Nephrol. 2020. https://doi.org/10.2215/CJN.08970719.

  30. Pham PTT, Pham PCT, Danovitch GM, Gritsch HA, Singer J, Wallace WD, Hayashi R, Wilkinson AH. Predictors and risk factors for recurrent scleroderma renal crisis in the kidney allograft: case report and review of the literature. Am J Transplant. 2005. https://doi.org/10.1111/j.1600-6143.2005.01035.x.

  31. Sagmeister MS, Grigorescu M, Schönermarck U. Kidney transplantation in ANCA-associated vasculitis. J Nephrol. 2019. https://doi.org/10.1007/s40620-019-00642-x.

  32. Sprangers B, Lefkowitz GI, Cohen SD, Stokes MB, Valeri A, Appel GB, Kunis CL. Beneficial effect of rituximab in the treatment of recurrent idiopathic membranous nephropathy after kidney transplantation. Clin J Am Soc Nephrol. 2010. https://doi.org/10.2215/CJN.04120609.

  33. Gupta G, Fattah H, Ayalon R, et al. Pre-transplant phospholipase A2 receptor autoantibody concentration is associated with clinically significant recurrence of membranous nephropathy post-kidney transplantation. Clin Transpl. 2016. https://doi.org/10.1111/ctr.12711.

  34. Berger BE, Vincenti F, Biava C, Amend WJ, Feduska N, Salvatierra O. De novo and recurrent membranous glomerulopathy following kidney transplantation. Transplantation. 1983. https://doi.org/10.1097/00007890-198304000-00010.

  35. Stegall MD, Cornell LD, Park WD, Smith BH, Cosio FG. Renal allograft histology at 10 years after transplantation in the tacrolimus era: evidence of pervasive chronic injury. Am J Transplant. 2018. https://doi.org/10.1111/ajt.14431.

  36. Fridell JA, Niederhaus S, Curry M, Urban R, Fox A, Odorico J. The survival advantage of pancreas after kidney transplant. Am J Transplant. 2019. https://doi.org/10.1111/ajt.15106.

  37. Kumar EP. Posttransplantation diabetes mellitus after renal transplantation – a brief overview. Int J Transplant Plastic Surg/ 2019. https://doi.org/10.23880/IJTPS-16000S1-004.

  38. Avasare RS, Rosenstiel PE, Zaky ZS, Tsapepas DS, Appel GB, Markowitz GS, Bomback AS, Canetta PA. Predicting post-transplant recurrence of iga nephropathy: the importance of crescents. Am J Nephrol. 2017. https://doi.org/10.1159/000453081.

  39. Czarnecki PG, Lager DJ, Leung N, Dispenzieri A, Cosio FG, Fervenza FC. Long-term outcome of kidney transplantation in patients with fibrillary glomerulonephritis or monoclonal gammopathy with fibrillary deposits. Kidney Int. 2009. https://doi.org/10.1038/ki.2008.577.

  40. Penn I. The effect of immunosuppression on pre-existing cancers. Transplantation. 1993. https://doi.org/10.1097/00007890-199304000-00011.

  41. Johnson SR, Cherikh WS, Kauffman HM, Pavlakis M, Hanto DW. Retransplantation after post-transplant lymphoproliferative disorders: an OPTN/UNOS database analysis. Am J Transplant. 2006. https://doi.org/10.1111/j.1600-6143.2006.01543.x.

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

    PubMed  Google Scholar 

  43. European best practice guidelines for renal transplantation (Part 1). Nephrol Dial Transplant. 2000. https://doi.org/10.1093/ndt/15.suppl_7.3.

  44. Maisonneuve P, Agodoa L, Gellert R, et al. Cancer in patients on dialysis for end-stage renal disease: an international collaborative study. Lancet. 1999. https://doi.org/10.1016/S0140-6736(99)06154-1.

  45. Muñoz P, Rodríguez C, Bouza E. Mycobacterium tuberculosis infection in recipients of solid organ transplants. Clin Infect Dis. 2005. https://doi.org/10.1086/427692.

  46. WHO. WHO | Global tuberculosis report 2019. World Heal Organ. 2020. ISBN: 9789241565714.

    Google Scholar 

  47. Milburn H, Ashman N, Davies P, Doffman S, Drobniewski F, Khoo S, Ormerod P, Ostermann M, Snelson C. Guidelines for the prevention and management of Mycobacterium tuberculosis infection and disease in adult patients with chronic kidney disease. Thorax. 2010. https://doi.org/10.1136/thx.2009.133173.

  48. Ferguson TW, Tangri N, MacDonald K, et al. The diagnostic accuracy of tests for latent tuberculosis infection in hemodialysis patients: a systematic review and meta-analysis. Transplantation. 2015. https://doi.org/10.1097/TP.0000000000000451.

  49. Abad CL, Razonable RR. Non-tuberculous mycobacterial infections in solid organ transplant recipients: an update. J Clin Tuberc Other Mycobact Dis. 2016. https://doi.org/10.1016/j.jctube.2016.04.001.

  50. British Transplantation Society. Guidelines for hepatitis B & solid organ transplantation. 1st ed; 2018.

    Google Scholar 

  51. Kidney Disease: Improving Global Outcomes (KDIGO) Hepatitis C Work Group. KDIGO 2018 clinical practice guideline for the prevention, diagnosis, evaluation, and treatment of hepatitis C in chronic kidney disease. Kidney Int Suppl. 2018. https://doi.org/10.1016/j.kisu.2018.06.001.

  52. Axelrod DA, Schnitzler MA, Alhamad T, et al. The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes. Am J Transplant. 2018. https://doi.org/10.1111/ajt.14895.

  53. Xia Y, Friedmann P, Yaffe H, Phair J, Gupta A, Kayler LK. Effect of HCV, HIV and coinfection in kidney transplant recipients: Mate kidney analyses. Am J Transplant. 2014. https://doi.org/10.1111/ajt.12847.

  54. The British Transplantation Society. Kidney & pancreas transplantation in patients with HIV. 2nd ed; 2015.

    Google Scholar 

  55. Stock PG, Barin B, Murphy B, et al. Outcomes of kidney transplantation in HIV-infected recipients. N Engl J Med. 2010. https://doi.org/10.1056/NEJMoa1001197.

  56. British Transplantation Society (BTS)/ The Renal Association (RA). Guidelines for living donor kidney transplantation. 4th ed; 2018.

    Google Scholar 

  57. Yamauchi J, Yamano Y, Yuzawa K. Risk of human T-cell leukemia virus type 1 infection in kidney transplantation. N Engl J Med.. 2019. https://doi.org/10.1056/NEJMc1809779.

  58. Kotton CN, Fishman JA. Viral infection in the renal transplant recipient. J Am Soc Nephrol. 2005. https://doi.org/10.1681/ASN.2004121113.

  59. Assi M, Martin S, Wheat LJ, et al. Histoplasmosis after solid organ transplant. Clin Infect Dis. 2013. https://doi.org/10.1093/cid/cit593.

  60. Wu HHL, Woywodt A, Nixon AC. Frailty and the potential kidney transplant recipient: time for a more holistic assessment? Kidney360. 2020. https://doi.org/10.34067/kid.0001822020.

  61. Garonzik-Wang JM, Govindan P, Grinnan JW, et al. Frailty and delayed graft function in kidney transplant recipients. Arch Surg. 2012. https://doi.org/10.1001/archsurg.2011.1229.

  62. McAdams-Demarco MA, Law A, Salter ML, Chow E, Grams M, Walston J, Segev DL. Frailty and early hospital readmission after kidney transplantation. Am J Transplant. 2013. https://doi.org/10.1111/ajt.12300.

  63. McAdams-Demarco MA, Law A, King E, et al. Frailty and mortality in kidney transplant recipients. Am J Transplant. 2015. https://doi.org/10.1111/ajt.12992.

  64. McAdams-DeMarco MA, Olorundare IO, Ying H, et al. Frailty and postkidney transplant health-related quality of life. Transplantation. 2018. https://doi.org/10.1097/TP.0000000000001943.

  65. McAdams-DeMarco MA, Ying H, Thomas AG, et al. Frailty, inflammatory markers, and waitlist mortality among patients with end-stage renal disease in a prospective cohort study. Transplantation.. 2018. https://doi.org/10.1097/TP.0000000000002213.

  66. Reese PP, Shults J, Bloom RD, Mussell A, Harhay MN, Abt P, Levine M, Johansen KL, Karlawish JT, Feldman HI. Functional status, time to transplantation, and survival benefit of kidney transplantation among wait-listed candidates. Am J Kidney Dis. 2015. https://doi.org/10.1053/j.ajkd.2015.05.015.

  67. Chu NM, Deng A, Ying H, Haugen CE, Garonzik Wang JM, Segev DL, McAdams-Demarco MA. Dynamic frailty before kidney transplantation: time of measurement matters. Transplantation. 2019. https://doi.org/10.1097/TP.0000000000002563.

  68. Knoll G, Cockfield S, Blydt-Hansen T, Baran D, Kiberd B, Landsberg D, Rush D, Cole E. Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation. CMAJ. 2005. https://doi.org/10.1503/cmaj.051291.

  69. Zlotnick DM, Axelrod DA, Chobanian MC, Friedman S, Brown J, Catherwood E, Costa SP. Non-invasive detection of pulmonary hypertension prior to renal transplantation is a predictor of increased risk for early graft dysfunction. Nephrol Dial Transplant. 2010. https://doi.org/10.1093/ndt/gfq141.

  70. Kasiske BL, Klinger D. Cigarette smoking in renal transplant recipients. J Am Soc Nephrol. 2000;11(4):753–759. https://doi.org/10.1681/ASN.V114753.

  71. Lentine KL, Costa SP, Weir MR, et al. Cardiac disease evaluation and management among kidney and liver transplantation candidates: A scientific statement from the American Heart Association and the American College of Cardiology Foundation. J Am Coll Cardiol. 2012. https://doi.org/10.1016/j.jacc.2012.05.008.

  72. Brown J, Morgan-Hughes NJ Aortic stenosis and non-cardiac surgery. Contin Educ Anaesth Crit Care Pain. 2005 https://doi.org/10.1093/bjaceaccp/mki001.

  73. Pritts CD, Pearl RG. Anesthesia for patients with pulmonary hypertension. Curr Opin Anaesthesiol. 2010. https://doi.org/10.1097/ACO.0b013e32833953fb.

  74. Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American college of cardiology/American heart association task force on practice guidelines. J Am Coll Cardiol. 2014. https://doi.org/10.1016/j.jacc.2014.07.944.

  75. Morkane CM, Fabes J, Banga NR, Berry PD, Kirwan CJ. Perioperative management of adult cadaveric and live donor renal transplantation in the UK: a survey of national practice. Clin Kidney J. 2019. https://doi.org/10.1093/ckj/sfz017.

  76. Ting SMS, Iqbal H, Kanji H, et al. Functional cardiovascular reserve predicts survival pre-kidney and post-kidney transplantation. J Am Soc Nephrol. 2014. https://doi.org/10.1681/ASN.2013040348.

  77. Moran J, Wilson F, Guinan E, McCormick P, Hussey J, Moriarty J. Role of cardiopulmonary exercise testing as a risk-assessment method in patients undergoing intra-abdominal surgery: a systematic review. Br J Anaesth. 2016. https://doi.org/10.1093/bja/aev454.

  78. Fabes J, Al Midani A, Sarna A, Hadi D, Banga N, Jones G, Berry P, Wittenberg M. Implementation of a novel algorithm to optimise fluid and vasopressor therapy in renal transplantation.

    Google Scholar 

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Authors and Affiliations

  1. Department of Nephrology & Transplantation, Royal Free London NHS Foundation Trust, London, UK

    Heidy Hendra, David Mathew, Aneesa Jaffer & Ammar Al Midani

  2. Renal Psychology Service, Royal Free London NHS Foundation Trust, London, UK

    Jeff Cove

  3. Department of Cardiology, Royal Free London NHS Foundation Trust, London, UK

    Paramjit Jeetley

  4. Department of Anaesthesia, Royal Free London NHS Foundation Trust, London, UK

    Clare Melikian

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    Mark Harber

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Hendra, H. et al. (2022). Assessment of the Potential Transplant Recipient. In: Harber, M. (eds) Primer on Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-030-76419-7_86

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