Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation

Knoll, Gregory A.

doi:10.1503/cmaj.1041588

Cited by 236 publications

(205 citation statements)

References 213 publications

(237 reference statements)

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“…These guidelines also note that there are insufficient data to suggest which, if any, obese patients should be denied a transplant based on their obesity [3]. The Canadian Transplant Society has released similar guidelines, although their statement regarding the lack of data for exclusion based on obesity is placed before their recommendation for weight reduction [4]. As a result of the lack of clear evidence, acceptable BMI limits for kidney transplant candidates vary across transplant centers.…”

Section: The Obesity Epidemic and Kidney Transplantationmentioning

confidence: 99%

Obesity and Kidney Transplant Candidates: How Big Is Too Big for Transplantation?

et al. 2012

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Obesity impacts many inter-related, and sometimes conflicting, considerations for transplant practice. In this article, we describe an approach for applying available data on the importance of body composition to the kidney transplant population that separates implications for candidate selection, risk stratification among selected candidates, and interventions to optimize health of the individual. Transplant recipients with obesity defined by elevated body mass index (BMI) have been shown in many (but not all) studies to experience an array of adverse outcomes more commonly than normal-weight transplant recipients, including wound infections, delayed graft function, graft failure, cardiac disease, and increased costs. However, current studies have not defined limits of body composition that preclude clinical benefit from transplantation compared with long-term dialysis in patients who have passed a transplant evaluation. Formal cost-effectiveness studies are needed to determine if payers and society should be compensating centers for clinical and financial risks of transplanting obese end-stage renal disease patients. Recent studies also demonstrate the limitations of BMI alone as a measure of adiposity, and further research should be pursued to define practical measures of body composition that refine accuracy for outcomes prediction. Regarding individual management, observational registry studies have not found beneficial associations of pretransplant weight loss with patient or graft survival. However, association studies cannot distinguish purposeful from unintentional weight loss as a result of illness and comorbidity. Prospective evaluations of the impact of targeted risk modification efforts in this population including dietary changes, monitored exercise programs, and bariatric surgery are urgently needed.

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Section: The Obesity Epidemic and Kidney Transplantationmentioning

confidence: 99%

Obesity and Kidney Transplant Candidates: How Big Is Too Big for Transplantation?

et al. 2012

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“…There are national guidelines on the evaluation of patients for transplantation but most do not explicitly state absolute contraindications to transplantation (3)(4)(5). The recently published Canadian Transplant Society consensus report looked more closely at eligibility criteria (5). There have been several studies examining selection and center practice (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Access to the Kidney Transplant Wait List

Kiberd

Boudreault

Bhan

et al. 2006

American Journal of Transplantation

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The study examines selection for kidney transplantation and determines who are referred, how many had contraindications and whether comorbidity indices predict transplant status. Of 113 consecutive adult incident end-stage renal disease (ESRD) patients at this single center 47 (41.6%) were referred. Using published guidelines, 48 (42.5%) had a specific contraindication. However 26 (23%) were neither referred nor had contraindications. An ESRD mortality score, acute renal failure status and albumin were independent predictors of referral but only the mortality score was predictive of contraindication status. The Charlson and ESRD comorbidity indices were less predictive of contraindication or referral status. In a comparison of patients who were Candidates (referred and no contraindication, n = 39) compared to those who were Neither (not referred and no contraindications, n = 26), age was the most discriminating factor (c = 0.99, 95% CI 0.97-1.00). Comorbidity and mortality indices were inferior. Neither patients were older (75 ± 7 years) and had comorbidity scores that were higher than Candidates but similar to those with contraindications (ESRD index; Neither 3.3 ± 2.5, Candidate 1.4 ± 1.8, and contraindication 4.1 ± 3.4). Comorbitity indices do not help explain selection practices whereas age is an important discriminator. How many Neither patients would benefit from transplantation is not known.

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“…Clinical practice guidelines for assessing kidney transplantation suitability recommend routine screening for exposure to mycobacteria using clinical history, chest radiograph, and purified protein derivative skin testing. 36 However, only up to 65% patients who have received intravesical BCG will have positive skin testing results, and the interferon-gamma release assay (IGRA) is not affected by BCG exposure. 37 Thus, the current methods used for mycobacteria screening may not be sensitive enough to identify all potential cases of latent mycobacterial infection.…”

Section: Discussionmentioning

confidence: 99%

DisseminatedMycobacterium bovisinfection post‐kidney transplant following remote intravesicalBCGtherapy for bladder cancer

Ziegler

Gibson

et al. 2018

Transplant Infectious Dis

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Intravesical Bacillus Camlette-Guérin (BCG) is the treatment of choice for non-muscle invasive bladder cancer, and has been used successfully for over 40 years. A rare and potentially fatal complication of intravesical BCG therapy is BCG-induced sepsis. We report a rare case in which a patient with end-stage renal disease secondary to chronic granulomatous interstitial nephritis underwent remote, pre-transplant intravesical BCG treatment for high-grade non-invasive papillary bladder carcinoma. The patient subsequently received a deceased donor kidney transplant 5 years after BCG therapy, with thymoglobulin induction therapy and standard triple maintenance immunosuppression. Two years post-transplant, he developed BCG-induced sepsis confirmed by cultures from urine, blood, and left native kidney biopsy. He died from disseminated BCG-induced sepsis and failure of his renal allograft. This case highlights the potential adverse reactions associated with intravesical BCG therapy that may occur years after bladder cancer therapy is completed, and should heighten physician awareness for BCG-related infections during pre-transplant assessment and post-transplant care of solid organ transplants recipients.

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Canadian Society of Transplantation: consensus guidelines on eligibility for kidney transplantation

Cited by 236 publications

References 213 publications

Obesity and Kidney Transplant Candidates: How Big Is Too Big for Transplantation?

Obesity and Kidney Transplant Candidates: How Big Is Too Big for Transplantation?

Access to the Kidney Transplant Wait List

DisseminatedMycobacterium bovisinfection post‐kidney transplant following remote intravesicalBCGtherapy for bladder cancer

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