Transplant assessment

Patients with irreversible kidney failure who either about to start dialysis or are already on dialysis can be considered for a kidney transplant. Some patients with kidney failure and diabetes may be considered for a combined kidney and pancreas transplant. Patients in the West of Scotland are initially assessed by their nephrologist (kidney doctor) and then referred to the transplant assessment clinic for further assessment.

Chronic kidney disease is irreversible gradual failure of the kidneys, and once a patient is expected to need to start dialysis within the next six months, or is already on dialysis, then they can go onto the waiting list for a kidney transplant.

Patients with type 1 diabetes getting a combined kidney and pancreas will, if the transplants are successful, both avoid dialysis and will also have normal blood sugar control without needing insulin. However, this is a much bigger operation with potentially major complications so not all patients are suitable. Some patients are suitable for a kidney transplant but not a combined kidney and pancreas transplant.

Heart and lung function

To go onto the waiting list, patients need to be fit enough to go through a major operation and so testing of heart and lung function is often needed. Diseases of the arteries are common in patients with kidney failure and can affect suitability for a transplant.

Basic tests of cardiovascular function are done for all patients: usually an ECG (electrical tracing of the heart) and an echocardiogram (ultrasound scan of the heart). If there is an apparent problem on these tests, or there are symptoms of cardiovascular disease, then an exercise tolerance test is usually done: this involves walking on a treadmill at gradually increasing speed while a continuous electrical tracing of the heart is monitored.

If these tests are abnormal, you may need a coronary angiogram which is an examination of the arteries around the heart by injection of x-ray dye through a narrow tube inserted into an artery in the groin or wrist; if the coronary angiogram shows narrowing of the arteries, you may need to have the narrowings treated by stretching them with a balloon inside the artery or by placement of tube called a stent to widen the artery.

If there is hardening or narrowing of the arteries in the pelvis, performing the transplant operation may be difficult or impossible. There is a higher risk of losing the kidney in this scenario, and it is also possible that you have an operation but the kidney is not actually transplanted. We may need to get pictures of the arteries, usually by a CT or MRI scan.

Infections and cancers

Kidney transplant recipients need immunosuppressant (anti-rejection) drugs to prevent rejection of the kidney, and this can cause problems if there is a longstanding infection or a history of cancer. Patients with longstanding infections will need treatment before they can go on the waiting list, and patients with previous cancers may need to wait for a few years to make sure the cancer does not come back before they can be transplanted.

Longstanding infections can include more obvious infections like abscesses and foot ulcers, but also more subtle infections like tuberculosis (TB), hepatitis B and hepatitis C. Patients with abscesses and foot ulcers would need to have these surgically treated and seen to be healing before going onto the transplant list.

Infections like TB and hepatitis do not always prevent a transplant going ahead as long as the patient is getting treatment and the infection appears to be controlled by that treatment, but often the treatment needs to be increased after the transplant.

In patients with polycystic kidneys or large kidney stones, sometimes the one or both of the native kidneys need to be removed before transplant.

Cancers can come back even after they have apparently been completely removed, but if they have not come back after a few years then the risk of the cancer returning becomes quite low - this risk varies between cancers. We generally need to wait until a few years after the cancer has been treated to check that it has not come back; how long that wait needs to be depends on the cancer and the urgency of the transplant.

Other medical conditions

Patients with a lot of other medical conditions are often transplanted successfully, but the immunosuppressant medications can worsen some other conditions (although sometimes it can actually improve inflammatory diseases), so the impact of other conditions will be discussed with you when you are assessed for a transplant.

Tissue typing

The transplant assessment includes taking blood samples to determine blood group and tissue type. These affect compatibility with donor organs. If you have previously received a transplant, a blood transfusion or been pregnant, you may have antibodies to other tissue types — we need to monitor these antibodies on a regular basis as the levels can vary and they do affect which organ donors can donate to you. More about tissue typing