For Kidney Transplant Recipients
1. Who is not eligible for kidney transplantation?
People with other underlying diseases can undergo kidney transplantation, provided they do not have the following conditions:
- Patients with severe psychiatric disorders or ongoing substance abuse, where it is considered that it may affect self-care after kidney transplantation
- Patients who do not adhere to treatment (Nonadherence) despite appropriate advice and it is considered that it may affect self-care after kidney transplantation
- Patients with unstable cancer
- Patients with active infection in the body
- Patients with severe irreversible lung disease that cannot be improved
- Patients with neurodegenerative diseases that are still progressing
- Patients with systemic diseases deemed unsuitable for kidney transplantation by the physician
2. Age of kidney transplant candidates
- Age alone should not be the sole criterion to determine if a patient is suitable for kidney transplantation
- It is recommended that if kidney transplantation is to be performed in patients over 65 years old, they should be informed about the benefits, risks, mortality chances, and complications compared to other kidney replacement therapies
- It is recommended to assess neurocognitive function in all pediatric patients who develop end-stage chronic kidney disease before the age of 5
3. Can patients with SLE undergo kidney transplantation?
It is recommended that SLE be in remission, possibly treated with medication and other kidney replacement therapies, for at least 1 year after remission before proceeding with kidney transplantation
4. Can cancer patients undergo kidney transplantation?
Cancer patients eligible for kidney transplantation depend on the stage of cancer. Patients with advanced cancer should not undergo transplantation. However, if the cancer is localized and has been treated to remission, transplantation may be considered at the physician’s discretion
5. Can heart disease patients undergo kidney transplantation?
Heart disease patients with treatable causes should have these corrected before kidney transplantation. However, patients with end-stage heart disease and poor heart contraction or severe coronary artery disease should not undergo kidney transplantation
For Kidney Donor Candidates
1. Criteria for living donors
Donors must be physically and mentally healthy as assessed by a physician and must have the following relationships with the chronic kidney disease patient:
Donors must be genetically related relatives:
a. Parents, children by birth, siblings born from the same parents, which can be legally or medically proven, such as HLA and/or DNA from parents
b. Uncles, aunts, nephews, nieces (meaning children of siblings with the same or half genetic relation), first cousins, or relatives with half genetic relation, such as half-siblings. In these cases, proof that the donor and recipient share DNA and/or HLA is required. Alternatively, donors may be legally married spouses or cohabiting partners openly living together with the recipient for at least three years. If they have biological children together, the three-year period is not required. If there is difficulty proving shared children, DNA testing should be used. Donors may also be organ transplant recipients who wish to donate their organs to others
2. Age of kidney donors
Initially, older donors interested in donating a kidney can do so after thorough evaluation confirming their suitability. Both donors and recipients should be informed about possible surgical complications and the expected functional lifespan of the transplanted kidney from an older donor. Using kidneys from older donors may cause several issues, including risks to the donor who may have chronic diseases and increased surgical risks, as well as reduced functional lifespan of the transplanted kidney due to age-related decline. Most international transplant centers use 65 years as an age criterion
3. Fitness criteria for kidney donors
The acceptable kidney function level for donation is a GFR >90 ml/min/1.73m2. Exclusion criteria include mGFR, mCrCl, or eGFR cr-cys less than 70 ml/min/1.73m2
4. Can kidney donors with diabetes donate?
Living kidney donor candidates diagnosed with diabetes or prediabetes should refrain from donating. All donor candidates undergo fasting plasma glucose testing after at least 8 hours of fasting, Hemoglobin A1c measurement, and a 75 g oral glucose tolerance test if at high risk for diabetes but screening is normal. Those found at risk for future diabetes should receive counseling about the risk and lifestyle modifications
5. Can living kidney donors with hypertension donate?
Kidney donors with hypertension without evidence of target organ damage and who can control blood pressure below 140/90 mmHg with no more than two antihypertensive medications, and who comply with treatment and follow-up, can be kidney donors. Patients should be advised about lifestyle changes and informed that blood pressure naturally increases with age and that the risk of hypertension may increase after kidney donation
Steps While Waiting for Kidney Transplantation
- Physician diagnoses end-stage chronic kidney disease
- Medical history taking, physical examination, and assessment of physical and mental readiness
- Blood tests to evaluate kidney function and other comorbidities, especially infections
- Tissue typing (HLA match)
- Regular blood tests for immunity and physical examinations
- Registration on the active waiting list
Dr. Methinee Sutthiwaikij
Nephrologist
Phyathai 2 Hospital
