Bootcongres

Background: Transplant centers differ in their criteria for the acceptance of potential recipients for kidney transplantation. Specifically, there is a lack of consensus concerning relative contraindications for transplantation such as obesity, cardiovascular disease and old age. Our transplant program has adopted a comparatively liberal approach to accepting transplant candidates which has resulted in evaluation and subsequent transplantation of a number of patients who had been judged unsuitable for transplantation by other transplant centers. The aim of this study was to investigate the outcomes of these patients. Methods: We identified all patients who received a kidney transplant at our center between January 2000 and March 2013 and had been regarded as unsuitable for transplantation in a prior evaluation at another Dutch transplant center. We scored the reasons for refusal, the type of transplantation procedure, post-operative complications, long-term complications, patient and graft survival, and how they experienced the transplantation and quality of life. All regular patients transplanted in 2010 at our center functioned as a control group for outcome parameters. Results: We identified 23 study patients transplanted between January 2000 and March 2013. The major reasons for refusal at other centers were obesity, old age and a history of malignancy. 61% had diabetes mellitus. The mean age was 53 years. The mean follow-up time after transplantation was 25,6 months during which 3 study patients died (13%) and one experienced death censored graft loss. Wound complications were significantly more frequent in the study group compared to controls, but subsided within 6 months post transplantation in all cases. As assessed by a questionnaire, patients perceived their quality of life as improved after transplantation and in general were satisfied with the decision to proceed with the transplantation, despite contrary advice elsewhere. 

Conclusions: Patients who had been declined for transplantation at other centers generally did well after transplantation with a highly satisfactory graft and patient survival. We can safely assume that the mortality in this group would have been higher if these patients had remained on dialysis. Transplantation seems to be the most suitable treatment for this group of patients. In view of the large diversity of acceptance criteria, further efforts are needed to reach consensus.