NephrologyTier 2Topic

Principles of renal replacement therapies - transplantation

Overview

Kidney transplantation is the RRT modality of choice for eligible patients - it offers superior survival, quality of life, and cost-effectiveness compared with long-term dialysis
Can be from a living donor (best outcomes, allows pre-emptive transplant before dialysis is needed) or a deceased donor

Waiting times

Waiting times for a deceased donor kidney are typically years in most programs, substantially longer than for living donor transplantation, which reinforces the value of early referral

Eligibility

Eligibility weighs cardiovascular risk, cancer history/remission status, infection risk, frailty, and expected survival benefit against the risks of surgery and lifelong immunosuppression
Age alone is not a contraindication - functional status and comorbidity burden matter more

Recipient workup and pre-emptive transplant

Recipient workup: cardiovascular assessment, cancer screening, infection screening (HIV, hepatitis B/C, TB), tissue typing (HLA) and crossmatching
Pre-emptive transplantation (before dialysis is needed) is preferred when feasible - best outcomes, avoiding dialysis-related morbidity altogether

After transplant

Post-transplant: lifelong immunosuppression (typically a calcineurin inhibitor + antimetabolite + corticosteroid) - see transplant immunosuppression
Outcomes are superior to dialysis across most patient groups - transplantation should be actively considered/offered to every suitable candidate, not reserved as a last resort

Related topics

Living vs deceased donor transplantation, immunosuppression regimens, transplant rejection, pre-emptive transplant referral timing

Outcomes

Graft survival and patient survival both substantially exceed matched patients remaining on dialysis - the survival benefit is present even accounting for surgical/immunosuppression risk

6 more sections, plus exam facts

Premium unlocks every note across every specialty, and the full exam fact library behind it.

Get premium access