Kidney Transplant

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Kidney Recipient Selection Criteria

Eligibility Criteria

  • Advanced chronic kidney disease
    • Patients should have a measured or estimated GFR < 25mL/min prior to beginning their kidney transplant evaluation
  • End stage kidney disease

Contraindications to Kidney Transplantation

Absolute contraindications

  • Malignancy
    • Untreated non-cutaneous malignancy
    • Treated malignancy with a high or undetermined risk of recurrence1
  • Cardiac
    • Uncorrectable severe coronary, cerebrovascular or peripheral arterial disease
    • Chronic LV failure with ejection fraction ≤ 25%
  • Pulmonary
    • Severe COPD (e.g., FEV1 < 1.25L)
    • Severe pulmonary hypertension (PA systolic pressure greater than 60 mmHg by right heart catheterization)
  • Other medical
    • BMI>39.5
    • Unacceptable diabetes control
      • HBA1c > 9
    • PTH ≥ 1250 pg/mL
    • Advanced Frailty
    • Significant active infection or chronic non-healing wound
    • Untreated latent TB
    • HIV infection with viral load > 50 copies/ml
    • Advanced cirrhosis with portal hypertension
      • Status of cirrhosis and portal hypertension should be determined at time of initial screening evaluation – discuss w/ physician/surgeon
    • Financial/social/psychosocial
      • Inadequate insurance coverage
      • Inadequate post-transplant medication coverage
        • VA prescription coverage is not acceptable
      • Inability to develop and commit to an acceptable plan for post-transplant transportation and care
      • Severe psychiatric illness
      • Active tobacco smoking by patients with diabetes, coronary artery disease, carotid artery stenosis, peripheral arterial disease or moderate-severe chronic lung disease
      • Active marijuana or alcohol abuse
      • Incarceration or home arrest

Relative Contraindications

  • Medical
    • Moderate pulmonary hypertension (Pulmonary artery systolic pressure 45--60mm Hg by right heart catheterization)
    • Presence of multiple comorbid conditions that, in combination, severely limit the benefit of kidney transplantation
  • Psychosocial
    • Active illegal drug use within the past 6 months, except for social marijuana use
    • Non-compliance with dialysis, prescriptions, medications, and appointments
    • Inability to perform activities of daily living or need for chronic custodial care
    • Currently serving parole or on probation