What is involved in an evaluation for kidney transplantation?

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The evaluation begins when your nephrologist refers you to a kidney transplant program for an evaluation. The evaluation is necessary to learn about the risks and benefits of transplantation for each patient. It is an opportunity to review your medical history and identify any potential problems that need further investigation. It is also an opportunity for you to learn about renal transplantation.

The evaluation involves meeting the members of the transplant team who will assess you. The transplant nephrologist (a medical physician with expertise in kidney disease and caring for kidney patients before and after transplantation) reviews the evaluation process with you, including the risks and benefits of transplantation. The transplant nephrologist reviews your medical history, examines you, and answers any questions.

The other members of the team include a dietitian, who reviews your nutrition history and plans a diet to help you prepare for transplantation. The social worker interviews you to determine if you have any special concerns about the process and have adequate support after your transplant. An infectious disease physician reviews your history of infections and your immunization history. The infectious disease physician determines if you are free of active infection and if we can anticipate any particular infections after transplant. Our financial coordinator discusses any insurance concerns you may have and any financial programs available to you. Our transplant surgeon explains in detail the risks and benefits of the surgery. The surgeon assesses whether it is technically possible to perform the surgery.

Throughout the process, our transplant nurse coordinator supports you and expedites your evaluation. The transplant nurse coordinator is an invaluable resource. She or he is your main contact at the transplant center. The transplant nurse coordinator also starts your formal education about kidney transplantation.

After meeting the members of the team, you will have some blood labs drawn and some diagnostic studies ordered. The screening laboratory tests include

• Complete blood count

• INR and partial prothrombin time

• Basic metabolic profile

• Liver function studies

• Glycosylated hemoglobin (patients with diabetes or suspected)

• Urinalysis with culture and sensitivity (if patient makes urine)

• ABO blood group (measured on two separate occasions)

• CMV, EBV, HSV, and varicella titers (viral studies)

• HIV (AIDS test)

• Hepatitis studies

• Quantiferon gold test (for tuberculosis)

• Twenty-four–hour urine for protein and creatinine clearance (or calculated GFR) for patients not on dialysis

Other diagnostic studies include (as required)

• Chest x-ray

• ECG (electrocardiogram)

• Renal ultrasound of native kidneys

• Cardiac evaluation for patients over 50 years of age (preferably a dobutamine stress test)

• High-risk patients (positive stress test, history of coronary artery disease, congestive heart failure, long history of diabetes mellitus, sedentary lifestyle) referred for cardiac consultation

• Dental letter (to demonstrate no active disease)

• Cancer screening as recommended by the American Cancer Society to include updated prostate-specific antigen (PSA), Pap, mammogram, and colonoscopy 

Other diagnostic studies that may be needed depending on the patient’s history include

• Pulmonary function studies

• Carotid Doppler

• Cardiac catheterization

• Voiding cystourethrogram (this is a test to study your bladder and how well it is working)

• Lower extremity arterial vascular studies

After your evaluation is complete your information is presented to the multidisciplinary transplant team selection committee. The purpose of the screening meetings is to review data accumulated during your outpatient evaluation process to determine the appropriateness of transplantation for each patient. Final decisions reached by the committee include accept and activate for transplantation, accept but not activate, or decision deferred or the patient is not considered an appropriate candidate for kidney transplantation. The patient is notified of his or her status within 10 business days from the selection committee’s meeting.

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