Summary of the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation

Abstract

The 2020 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Management of Candidates for Kidney Transplantation is intended to assist health care professionals worldwide who evaluate and manage potential candidates for deceased or living donor kidney transplantation. This guideline addresses general candidacy issues such as access to transplantation, patient demographic and health status factors, immunological and psychosocial assessment. The roles of various risk factors and comorbid conditions governing an individual’s suitability for transplantation such as adherence, tobacco use, diabetes, obesity, perioperative issues, causes of kidney failure, infections, malignancy, pulmonary disease, cardiac and peripheral arterial disease, neurologic disease, gastrointestinal and liver disease, hematologic disease, and bone and mineral disorder are also addressed. This guideline provides recommendations for evaluation of individual aspects of a candidate’s profile such that each risk factor and comorbidity are considered separately. The goal is to assist the clinical team to assimilate all data relevant to an individual, consider this within their local health context, and make an overall judgment on candidacy for transplantation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach. Guideline recommendations are primarily based on systematic reviews of relevant studies and our assessment of the quality of that evidence. The strengths of recommendations are provided in the full report. Limitations of the evidence are discussed with differences from previous guidelines noted and suggestions for future research are also provided.

Aorto-Iliac Artery Calcification and Graft Outcomes in Kidney Transplant Recipients

“…This is the first study evaluating the association between aorto-iliac calcification and one-year graft function in multivariable analysis, including patient, transplantation, and follow-up covariables. Second, the aorto-iliac CaScore is an easy-to-implement assessment, as the software is readily available in standard imaging analysis packages and pre-transplant CT-imaging is advised for high-risk transplant candidates [ 39 , 40 ]. Third, the discrepancy between the results of Kaplan–Meier survival analysis and multivariable Cox regression analyses highlights the importance of relatively large cohort studies that enable adjustment for important covariables.…”

Aorto-Iliac Artery Calcification Prior to Kidney Transplantation

“…To date, CT imaging of the aorto-iliac vessels prior to kidney transplantation is primarily performed for surgical planning, while the available imaging data are not widely used for cardiovascular risk stratification in clinical practice [25,26]. As the imaging data are available, non-contrast enhanced CT-based quantification of aortic calcification can be used for cardiovascular risk stratification of patients screened for kidney transplantation, without the need for additional procedures [27,28].…”

A propensity score–matched analysis indicates screening for asymptomatic coronary artery disease does not predict cardiac events in kidney transplant recipients

“…Importantly, patients were excluded if they had unprotected left main stem disease or an ejection fraction below 35%, but in individuals without these features no reduction in death or myocardial infarction was observed with angioplasty over best medical therapy 33. This is reflected in the 2020 KDIGO guidelines which recommend asymptomatic patients not undergo revascularisation solely to reduce perioperative risk 34. Third, the absence of a clear benefit from revascularisation suggests a different aetiology for cardiovascular disease in people with CKD.…”