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Transplant Center

Kidney Transplant Program

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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

  1. Idiopathic and postinfectious crescentic
  2. Membranous
  3. Mesangiocapillary (Type I)
  4. Mesangiocapillary (Type II) (dense-deposit disease)
  5. IgA nephropathy
  6. Antiglomerular basement membrane
  7. Focal glomerulosclerosis
  8. Henoch-Schonlein

Chronic pyelonephritis (reflux nephropathy)

Hereditary

  1. Polycystic kidneys
  2. Nephronophthisis (medullary cystic disease)
  3. Nephritis (including Alport's syndrome)
  4. Tuberous sclerosis

Metabolic

  1. Diabetes mellitus
  2. Hyperoxaluria
  3. Cystinosis
  4. Fabry's disease
  5. Amyloid
  6. Gout
  7. Porphyria

Obstructive nephropathy

Toxic

  1. Analgesic nephropathy
  2. Opiate abuse

Multisystem Diseases

  1. Systemic lupus erythematosus
  2. Vasculitis
  3. Progressive systemic sclerosis

Haemolytic uraemic syndrome

Tumors

  1. Wilms' tumor
  2. Renal cell carcinoma
  3. Incidental carcinoma
  4. Myeloma

Congenital

  1. Hypoplasia
  2. Horseshoe kidney

Irreversible Acute Renal Failure

  1. Cortical necrosis
  2. 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 this time 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 obviating the need for costly dialysis access surgery.

However, patients cannot be listed on the UNOS waiting list for a cadaver kidney until their creatinine clearance (Clcr) calculated by the Cockcroft-Gault formula is less than 30ml/min. The Cockcroft-Gault formula for calculation of the Clcr is now considered to be superior to actual measured creatinine clearance as determined by 24-hour urine collection, due to inherent inaccuracies and collection difficulties. The formula is as follows:

Clcr (ml/min) = (140-age)(wt. kg)
                         creatinine (mg/dl) x72

For women, the result is multiped by 0.85

Future UNOS listing criteria may further reduce this minimum

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 that 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:

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Contraindications for Kidney Transplantation

There are certain absolute contraindications to renal transplantation:

  1. Disseminated or untreated cancer
  2. Severe psychiatric disease
  3. Unresolvable psychosocial problems
  4. Persistent substance abuse
  5. Severe mental retardation
  6. Un-reconstructable coronary artery disease or refractory congestive heart failure

Relative contraindications:

  1. Treated malignancy. The cancer-free interval required will vary from two to five years depending on the stage and type of cancer. Consultation with a board-certified oncologist is required in these cases.

  2. 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.

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

  4. 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 consideration.

  5. Structural genitourinary abnormality or recurrent urinary tract infection. Urologic consultation is required prior to consideration.

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

  7. 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. In most cases, this consultation will be performed by Stephen Bartlett, M.D., director of transplantation, who is board certified in vascular surgery (American Board of Surgery, certificate of added qualifications in vascular surgery #10002). Patients with significant aortoiliac occlusive disease may require angioplasty or aortoiliac grafting prior to transplantation.

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If you would like to make an appointment or talk to someone about our services, please call 410-328-5408 or 1-800-492-5538.

This page was last updated on: February 18, 2008.