YOU NEED A KIDNEY TRANSPLANT – WHAT WORKUP IS REQUIRED?
Kidney transplantation is offered to patients who are already on dialysis or are going to need this treatment soon. In the latter case, receiving a transplant prior to being on dialysis is called pre-emptive transplantation. Multiple studies have shown that a successful kidney transplant enhances the quality of life and can also add years to your life as well. In short, a kidney transplant can be a life-saving operation, if it is well taken care of.
Exhaustive evaluations are generally required for all potential transplant candidates. This is done to make sure that any potential issue that could harm the transplanted kidney or the patient is identified and corrected prior to listing. After most of the testing has been done, the candidate is required to meet the transplant team which comprises of a transplant nephrologist, transplant surgeon, pre-transplant co-ordinator, transplant social worker and a financial advisor working with the program. Therefore, not only are medical issues looked into, social and financial issues are carefully evaluated as well.
Most work-ups start with lab studies. These include:
a) Blood chemistries (includes electrolytes, kidney function etc)
b) Liver function tests
c) Complete blood count (hemoglobin, platelet and white blood cell counts)
d) Coagulation profile (to check the ability of the blood to clot)
Further testing is ordered to rule out potential infections, especially certain viral infections. These include:
a) Hepatitis B and C
b) Epstein Barr virus
d) Varicella zoster virus
e) Syphilis testing
g) PPD for TB
The transplant team carefully looks at all organ systems, especially the heart, particularly if there is a prior history of heart related issues, if the patient has type 1 diabetes or if high blood pressure is the cause of renal failure.
This starts with:
a) Chest x-ray
c) Stress test
e) Heart catheterization, if required.
In addition to the blood tests outlined above, tests to identify the blood group and certain pre-existing antibodies that could cause rejection of the organ are done as well. Specifically, the transplant team would want:
a) ABO blood group determination
b) HLA typing
c) Antibodies to HLA phenotypes
While these tests are standard in all potential candidates, further tests may be required, which are:
a) PSA to rule out prostate cancer
b) Pap smear
c) Colonoscopy, if age > 50 years or if family history of colon cancer is present
d) Upper endoscopy with history of peptic ulcers
e) Dental check up to rule out infections
f) Urine testing in patients who still make some urine
g) Carotid duplex to look at carotid arteries for atherosclerotic plaques
h) Ultrasound of the native kidneys
i) Doppler studies of the arteries in the legs and arms
Any of these tests could reveal abnormalities that could either rule out a patient from being considered for a transplant. For example, a colonoscopy might reveal colon cancer, which will require further treatment and possibly being ruled out from getting a transplant for at least 2-3 years.
Most centers take a very close look at obesity. Most transplant centers will not consider a patient as a candidate if the BMI is more than 40.
A significant part of the evaluation process is looking at the candidate’s psychosocial and family support situation. If there is a history of a major psychiatric condition, this needs to be evaluated by a psychiatrist prior to listing.
Also, it is very important to have some kind of family support for the care that is going to be required for the patient before and after transplantation.
Compliance with treatment is looked at seriously. Any issue with non-compliance may rule a patient out because the transplant team needs to make sure that a scarce resource such as an organ will not be wasted on someone who does not comply with the treatment regimen after the transplant.
During all this, any potential living donor is also worked up with some basic tests and an interview by the transplant team. He is evaluated to see if he would be a good match from the immunologic standpoint and to see if he is under any coercion or pressure to come forward as a donor.