A kidney transplant involves the surgical removal of a kidney from a cadaver, living-related, or living-unrelated donor and transplantation into the recipient.
Based on data from the Organ Procurement and Transplantation Network in 2011, about a third of kidney transplants in the U.S. (5,769 of 16,812) were performed using organs from living donors. (1) As of March 23, 2012, the 5-year survival rate for kidney transplants performed between 1997 and 2004 was 66.5% for organs from deceased donors and 79.7% for organs from living donors.
Combined kidney-pancreas transplant and management of acute rejection of kidney transplant using either intravenous immunoglobulin (IVIg) or plasmapheresis are discussed in separate policies.
End-stage renal disease (ESRD) is stage 5 chronic renal disease; ESRD is chronic, permanent failure of the kidneys, as measured by serum creatinine and the glomerulofiltration rate. There are many causes of ESRD including, but are not limited to, any of the following conditions:
- Acute tubular necrosis
- Amyloid disease
- Analgesic nephropathy
- Anti-glomerular base-membrane disease
- Chronic pyelonephritis
- Cortical necrosis
- Diabetes mellitus
- Fabry's disease
- Focal glomerulosclerosis
- Gout nephritis
- Heavy metal poisoning
- Hemolytic uremic syndrome
- Henoch-Schönlein purpura
- Horseshoe kidney
- Hypertensive nephrosclerosis
- IGA nephropathy
- Medullary cystic disease
- Myeloma in remission
- Obstructive uropathy
- Polycystic kidney disease
- Renal aplasia or hypoplasia
- Renal artery or vein occlusion
- Renal-cell carcinoma
- Systemic lupus erythematosus
- Trauma requiring nephrectomy
- Tuberous sclerosis
- Wegener's granulomatosis
- Wilms’ tumor
Potential contraindications to solid organ transplant (subject to the judgment of the transplant center):
- Known current malignancy, including metastatic cancer;
- Recent malignancy with high risk of recurrence;
- History of cancer with a moderate risk of recurrence;
- Systemic disease that could be exacerbated by immunosuppression;
- Untreated systemic infection making immunosuppression unsafe, including chronic infection;
- Other irreversible end-stage disease not attributed to kidney disease;
- Psychosocial conditions or chemical dependency affecting ability to adhere to therapy.
HIV (human immunodeficiency virus)-positive patients, who meet the following criteria, as stated in the 2001 guidelines of the American Society of Transplantation, could be considered candidates for kidney transplantation:
- CD4 count >200 cells per cubic millimeter for >6 months;
- HIV-1 RNA undetectable;
- On stable antiretroviral therapy >3 months;
- No other complications from AIDS (acquired immune deficiency syndrome) (e.g., opportunistic infection, including aspergillus, tuberculosis, coccidiosis mycosis, resistant fungal infections, Kaposi’s sarcoma, or other neoplasm); and
- Meeting all other criteria for transplantation.
Indications for renal transplant include a creatinine level of greater than 8 mg/dL, or greater than 6 mg/dL in symptomatic diabetic patients. However, consideration for listing for renal transplant may start well before the creatinine level reaches this point, based on the anticipated time that a patient may spend on the waiting list.