Renal transplantation prolongs life, reduces morbidity, improves quality of life, and enables social rehabilitation of patients with end stage renal disease (ESRD). Kidney transplantation is a surgical procedure with inherent risks due to anesthesia and the surgical procedure itself. In ESRD patients medical background and comorbidities are crucial at the time of considering a renal transplant candidate because they can determine the procedure success
Objectives: To update and review, according to recent literature, the evaluation of renal transplant candidates.
Methods: We performed a retrospective review of medical literature published in Medline/Pubmed about the most important facts of medical, urological and oncological evaluation of ESRD patients candidates to renal transplant.
Results: Pretransplant medical evaluation aims to diagnose, treat, and optimize any preexisting disease, and how these can interfere with patient and graft survival. It is important to consider age, cardiovascular disease, presence of diabetes mellitus, coagulation disorders, obesity, gastrointestinal diseases, ESRD situation and associated complications, active infection and non compliance with treatment and follow up. Urological requirements for successful renal transplantation are the absence of urinary infections, a compliant and continent reservoir, and a reliable method of achieving complete bladder evacuation. Certain urological diseases may not be obvious in the anuric patient. Pretransplant urological evaluation aims to diagnose, treat, and optimize any preexisting urological disease that can jeopardize transplant evolution. Cancer is a frequent and recognized complication of organ transplantation. The need of continuous immunosuppressive therapy may lead to immunosuppression-related side effects and direct oncogenic effects. Pre-existing malignancies should be extensively evaluated before proceeding to transplantation. Appropriate screening for malignancies is recommended in ESRD patients during routine pretransplant evaluation.
Conclusion: This review highlights the importance of performing a comprehensive medical, urological and oncological assessment before transplantation. We will go through these mayor aspects of the evaluation of ESRD patients, how these might affect renal transplantation, which complementary test should be performed, and what are the latest recommendations for those situations. Careful pre-operative work-up of every transplant candidate is mandatory to improve post-transplant organ and patient survival. The workup should be tailored according to patients ' specific conditions, by a multidisciplinary approach before proceeding to transplantation.