Ineligibility for renal transplantation: prevalence, causes and survival in a consecutive cohort of 445 patients.
Little is known about the proportion of renal transplant candidates who are considered ineligible by the transplant center, the reasons of their ineligibility and their survival during dialysis. In this retrospective, single-center study of 445 adult patients referred between 2001 and 2006, 36 (8%) were deemed ineligible for medical contraindications. The leading reason was cardiovascular (CV) (75%), specifically aorto-iliac, and/or limb vessels atheromatosis or calcifications; ischemic heart disease; or a combination thereof. Nine patients had other contraindications that were absolute for three of them; six patients displayed a combination of relative contraindications. When compared to eligible patients (N = 409), those ineligible were significantly older (60 yr vs. 48), more often diabetics (50% vs. 15%), obese (39% vs. 17%) suffering from coronary artery disease (53% vs. 11%) and peripheral arterial disease (86% vs. 11%). Their primary nephropathy was more often diabetic and/or hypertensive/nephroangiosclerosis (61% vs. 23%), and their median dialysis vintage prior to evaluation was longer (29 months vs. 10, p < 0.0001). The actuarial survival of ineligible patients was significantly lower than that of eligible patients (at five yr: 53% vs. 88%). Adequate control of CV risk factors before dialysis and early referral for transplantation might help to improve eligibility of renal transplant candidates.
Kianda
Mireille N
MN
Renal Transplantation Clinic, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. mkianda@gmail.com
Wissing
Karl M
KM
Broeders
Nulifer E
NE
Lemy
Anne
A
Ghisdal
Lidia
L
Hoang
Anh D
AD
Mikhalski
Dimitri
D
Donckier
Vincent
V
Vereerstraeten
Pierre
P
Abramowicz
Daniel
D
D000328:Adult; D001530:Belgium / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D015995:Prevalence; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome