Defining high risk in adult kidney transplantation.
BACKGROUND
Because identifiable factors contribute to allograft loss, and because no consensus has been reached on the definition of high risk, an interdisciplinary group of nurses, physicians, pharmacists, and social workers was convened in May 2008.


OBJECTIVE
Participants sought to reach consensus about the current state of science and best practices related to the definition and management of high-risk kidney transplant recipients.


METHODS
An expert facilitator with extensive experience in leading consensus teams guided consensus-building activities, which included discussion and small-group work.


RESULTS
This consensus group conceptualized the definition of the "high-risk" kidney transplant recipient and provided information to guide the multidisciplinary team in their assessment of these patients before and after transplant. Three key areas, which were conceptualized as independent scales, had a substantial impact on outcomes: (1) transplant recipient medical factors, (2) donor and recipient immunological factors, and (3) transplant recipient psychosocial factors. Though depicted separately, alteration of a specific risk on one scale could influence some risk factors on another scale. In addition, the kidney allograft itself must be considered in the assessment of high risk.


CONCLUSIONS
The continuum of risk described here should be useful to transplant clinicians in their assessment of high-risk adult kidney transplant patients, may aid centers in developing a more complete definition of high risk, and may lead to risk-reduction efforts.
D000328:Adult; D000465:Algorithms; D019985:Benchmarking / Q000458:organization & administration; D001788:Blood Grouping and Crossmatching; D003663:Decision Trees; D046148:Donor Selection; D006084:Graft Rejection / Q000209:etiology* / Q000517:prevention & control; D006085:Graft Survival; D006304:Health Status; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology / Q000523:psychology; D008603:Mental Health; D010348:Patient Care Team / Q000458:organization & administration*; D018579:Patient Selection; D018570:Risk Assessment / Q000458:organization & administration*; D012307:Risk Factors; D040242:Risk Reduction Behavior; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D016896:Treatment Outcome