| Abstract: |
The preparation of patients with end-stage renal disease for kidney transplantation should start from the time of recognition of progressive chronic kidney disease (CKD). This chapter on the evaluation and preparation of renal transplant candidates is from a handbook that offers a practical guide for health care providers who manage kidney transplant patients. The authors note that the management of these patients consists of an initial evaluation followed, if they are appropriate transplant candidates, by their supervision while awaiting transplantation. Initial evaluation is designed not only to assess the chances of recovery from surgery, but also to increase short- and long-term patient survival. The limited number of organs available has changed the focus of the transplant evaluation toward better long-term outcome over short-term benefits. The authors first focus on the initial recipient evaluation and then consider the management of the waiting list for deceased donor transplantation. Specific topics covered include the benefits of early referral, patient education, the routine evaluation, the evaluation of specific transplant risk factors related to organ system disease (cardiovascular disease, cerebrovascular and peripheral vascular disease, malignancy, infections, gastrointestinal disease, pulmonary disease, urologic evaluation, renal osteodystrophy and metabolic bone disease, and hypercoagulable states), and risk factors related to specific patient characteristics (aged, obesity, highly sensitized patients, previously transplanted patients, and candidates for double-organ transplants). An additional section considers the relevance of the etiology of renal disease to the transplant evaluation, including diabetes mellitus, focal and segmental glomerulosclerosis, recurrent glomerulonephritis, thrombotic thrombocytopenic purpura, systemic lupus erythematosus and vasculitis, oxalosis and oxaluria, Fabry disease, Alport syndrome, sickle cell disease, amyloidosis and plasma cell dyscrasias, and polycystic kidney disease. 1 figure. 5 tables. 16 references. |