Kidney transplantation

Abstract Patients with end-stage kidney disease require either dialysis or kidney transplantation, if they are to survive. The former requires creation of vascular access to enable haemodialysis or insertion of a peritoneal catheter for peritoneal dialysis. Kidney transplantation offers selected patients with end-stage-renal-failure (ESRF) a survival advantage and improved quality of life compared to dialysis. Many patients with ESRF are frail and elderly with major co-morbidity that precludes transplantation. Careful assessment of suitability for transplantation is important, particularly with respect to cardiovascular disease, malignancy and infection. There is a twofold to threefold shortage of donor kidneys and patients listed for deceased donor kidney transplant wait an average of 3 years. Deceased donor kidneys are allocated through a points-based national allocation scheme that favours HLA matching and recipients who have waited longest. Living donor transplants (genetically related and unrelated) comprise over a third of UK transplants and offer the best chance of long-term rehabilitation. Potential live donors require extensive evaluation to confirm their medical suitability to donate. Nephrectomy is undertaken laparoscopically and has a 5% major per-operative complication rate. At the time of renal transplant, careful attention to pre-operative care and early post-operative management is important for maximising success. The early results of transplantation are very good, but in the longer term chronic allograft nephropathy commonly accounts for graft failure. The half-life of a kidney transplant is around 15 years. Results are less good for recipients of kidneys from expanded criteria donors and best for recipients of living donor kidneys.