Kidney

Clinical practice guidelines for the assessment of potential kidney transplant recipients reviewed access to renal transplantation and the evaluation, and selection and preparation of potential transplant recipients (Dudley & Harden, 2011). Nine recommendations for the pre-transplant assessment, evaluation, selection and screening of potential renal transplantation recipients are provided. These include guidelines for patients with cancer and prior testing for viral infections (Dudley & Harden, 2011).

  • Potential recipients of renal transplantation with previous malignancy (excluding non-melanoma skin cancer) should only be considered if there is no evidence of persistent cancer. The recommended waiting time between successful tumour treatment/remission and transplantation should be at least 2 years, and extended to longer than 5 years for some malignancies (Dudley & Harden, 2011).
  • Potential recipients should undergo testing for cytomegalovirus (CMV), Epstein-Barr virus (EBV), varicella zoster virus (VZV), hepatitis B and C and human immunodeficiency virus (HIV) (Dudley & Harden, 2011).

BK virus (BKV) can cause graft dysfunction or failure in kidney transplant recipients and haemorrhagic cystitis in allogeneic HSCT patients. A review by Elfadawy et al. (2018) gives an overview of BK virology, epidemiology, diagnosis and management. BK virus-associated nephropathy (BKVAN) emerged as a common complication in the late 1990s, probably due to the introduction of potent immunosuppressive agents. BKVAN occurred in up to 5% of kidney transplant recipients, with graft failure in up to 70%. Since universal implementation of effective screening and treatment strategies, BKV is no longer a common cause of graft failure and reported graft loss is only 0% to 5%.

A review of international guidelines published between 2001 and 2011 for patients on waiting lists for kidney transplantation identified some inconsistencies between guidelines regarding eligibility criteria (Batabyal et al., 2012).

European Renal Best Practice Guidelines on evaluation of kidney donors and recipients, and perioperative care have recently been published (Abramowicz et al., 2015).

The British Transplantation Society has developed guidelines for kidney and/or pancreas transplantation in patients with HIV (British Transplantation Society, 2015).

A retrospective study was performed to investigate the effect of higher donor age on graft function and kidney transplantation (Magott-Procelewska et al., 2018). The single-centre study followed 345 adult transplant recipients during the post-transplant course (median, 9.4 years). Fifty-eight patients received kidneys from donors at least 55 years old. An improvement in the estimated glomerular filtration rate at 36 months after transplantation was a good prognostic factor for long-term kidney function. Higher donor age decreased the chance for improvement of kidney function by 2.8% per year of life (p=0.0244). A higher uric acid level was associated with inferior kidney function in recipients of older kidneys while recipients of older kidneys with normal uric acid level presented satisfactory outcomes. The results suggest an important association between older donor age and decreased allograft function in kidney recipients with an elevated uric acid level.