Kidney and pancreas transplant candidacy

Abstract

Purpose of review Kidney and/or pancreas transplantation candidacy criteria have evolved significantly over time reflecting improved pre and post-transplant management. With improvement in medical care, potential candidates for transplant not only are older but also have complex medical issues. This review focuses on the latest trends regarding candidacy for kidney and/or pancreas transplantation along with advances in pretransplant cardiac testing. Recent findings More candidates are now eligible for kidney and/or pancreas transplantation owing to less stringent candidacy criteria especially in regards to age, obesity, frailty and history of prior malignancy. Pretransplant cardiovascular assessment has also come a long way with a focus on less invasive strategies to assess for coronary artery disease. Summary Criteria for kidney and/or pancreas transplantation are expanding. Patients who in the past might have been declined because of numerous factors are now finding that transplant centers are more open minded to their candidacy, which could lead to better access to organ transplant wait list.

The burden of coronary heart disease in simultaneous pancreas-kidney transplantation: coronary angiography as a diagnostic method for all? - a retrospective study

“…The single risk factor for CAD in our study was smoking, contradicting previous studies that indicated that age was the most significant factor. 10,11 Duration of T1DM also seemed to be relevant. In our cohort, 20 or more years of T1DM were found to be significantly associated with the presence of coronariopathy and/ or CAD.…”

“…Over the past decade, the surgical technique has consistently improved, but the complexity of SPKT candidates is a growing challenge. Nowadays, candidates are older, more of them are obese, and frequently have a higher burden of comorbidities 6 , 10 . Considering the CV impact on SPKT recipients, it seems imperative to detect and treat significant CAD before transplantation to limit the selection to those with acceptable cardiac risk 8 , 9 .…”

Expanding the access to kidney transplantation: Strategies for kidney transplant programs

“…27 Many concerns surround KT in obese candidates such as surgical complications and premature death censored graft loss. 105 Nevertheless, these patients have a clear survival benefit with KT compared to remaining on dialysis. 106,107 It is imperative to identify ways to facilitate safe transplants in this group.…”

Temporal Trends in Renal Replacement Therapy in Community-Based People with or without Type 2 Diabetes: The Fremantle Diabetes Study

“…In addition, the decision to start RRT may depend on local eligibility criteria, as well as the availability of specialist renal services, dialysis facilities, and donor kidneys. These factors, which may disadvantage people with diabetes and associated comorbidities such as obesity and CVD [18][19][20], are likely to differ across countries and change with time. An important additional consideration in access to and uptake of RRT remains ethnic/racial background.…”