Ineligibility for renal transplantation: prevalence, causes and survival in a consecutive cohort of 445 patients

Abstract

Little is known about the proportion of renal transplant candidates who are considered ineligible by the transplant center, the reasons of their ineligibility and their survival during dialysis. In this retrospective, single-center study of 445 adult patients referred between 2001 and 2006, 36 (8%) were deemed ineligible for medical contraindications. The leading reason was cardiovascular (CV) (75%), specifically aorto-iliac, and/or limb vessels atheromatosis or calcifications; ischemic heart disease; or a combination thereof. Nine patients had other contraindications that were absolute for three of them; six patients displayed a combination of relative contraindications. When compared to eligible patients (N = 409), those ineligible were significantly older (60 yr vs. 48), more often diabetics (50% vs. 15%), obese (39% vs. 17%) suffering from coronary artery disease (53% vs. 11%) and peripheral arterial disease (86% vs. 11%). Their primary nephropathy was more often diabetic and/or hypertensive/nephroangiosclerosis (61% vs. 23%), and their median dialysis vintage prior to evaluation was longer (29 months vs. 10, p < 0.0001). The actuarial survival of ineligible patients was significantly lower than that of eligible patients (at five yr: 53% vs. 88%). Adequate control of CV risk factors before dialysis and early referral for transplantation might help to improve eligibility of renal transplant candidates.

Kidney transplant referral practices in southeastern dialysis units

“…In our study, about one-third (37%) of facilities reported that >75% of their patients are ineligible for transplantation; however, previous literature from single-center studies estimate ineligibility for kidney transplantation to be <15% (13, 14). The majority of respondents (61.05%) report that they refer <50% of their patients for KTx.…”

“…Efforts that help dialysis patients get kidney transplants should also include promotion of living donor transplantation that are not dependent on the availability of the country’s overall low number of deceased donor organs (18). Regardless of donor organ supply or transplant center capacity, all dialysis patients must be informed about all of their treatment options including KTx (4,13). …”

Variation in Dialysis Facility Referral for Kidney Transplantation Among Patients With End-Stage Renal Disease in Georgia

“…Ineligibility due to medical contra indications is estimated to be less than 15% in the few single-center studies that have been conducted. 11,12 However, determination of eligibility for transplantation is complex and varies across transplant centers. Although active drug or alcohol abuse, untreated psychiatric conditions, active cancer, systemic infection, and non adherence are common exclusion criteria for transplant surgery, 13 none are permanent conditions that necessarily preclude transplant referral.…”

The prognosis of kidney transplant recipients with aorto‐iliac calcification: a systematic review and meta‐analysis

“…Severe VC in the aorto‐iliac arteries has been considered as a relative contra‐indication for kidney transplantation (KTx). It has been found that 43% of all transplant candidates who are considered ineligible is due to VC .…”