Fast Five Quiz: Organ Donation and Transplant

Beje Thomas, MD; Soon Youn Yi, MD

Disclosures

December 06, 2018

Contraindications for renal transplantation surgery include:

  • Metastatic cancer

  • Ongoing or recurring infections that are not effectively treated

  • Serious cardiac or peripheral vascular disease

  • Hepatic insufficiency (patients may be candidates for simultaneous liver-kidney transplantation)

  • Serious conditions that are unlikely to improve after renal transplantation (ie, the patient's life expectancy can be finitely measured)

  • Demonstrated and repeated episodes of medical noncompliance

  • Inability to perform rehabilitation adequately after transplantation

HIV seropositivity is not a contraindication for kidney transplantation, provided that the patient meets the following criteria:

  • The CD4 count has been higher than 200/µL for at least 6 months

  • HIV-I RNA is undetectable

  • The patient has been stable on antiretroviral therapy for at least 3 months

  • The patient has no major infectious or neoplastic complications

The risk for recurrent disease is not a contraindication for renal transplantation. Glomerulonephritides (eg, mesangiocapillary glomerulonephritis type 1 and immunoglobulin A nephropathy) are most likely to recur. However, loss of the kidney generally occurs late; thus, these diseases are not contraindications for transplantation. Similarly, patients with diabetes mellitus have poorer outcomes after transplantation than patients without diabetes; nearly all of them demonstrate histologic evidence of diabetic nephropathy within 4 years. However, the improved quality of life for patients with diabetes after transplantation justifies its use as the treatment of choice for these patients if they have end-stage renal disease.

In general, one should wait about 5 years after successful treatment of breast cancer, colorectal cancer, melanoma, diffuse bladder carcinoma, and non–in situ ovarian cancer. Some tumors may permit shorter waiting times. For isolated nodules of prostatic carcinoma and focal bladder carcinoma, 1 year (or even less) is reasonable; for in situ uterine carcinoma, some renal tumors (eg, clear cell, Wilms' tumor, urothelioma), and basal cell carcinoma or squamous cell skin carcinoma, no waiting time at all may be reasonable.

For more on renal transplantation, read here.

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