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Kidney and Pancreas Patient Selection Criteria

Indications

Any condition that results in end-stage renal disease (defined: GFR<15 (stage V CKD); GFR<20 for DDRT (stage IV CKD); Recipients with living donors may have GFR 20-30 (stage IV CKD)) including, but not limited to:

  • Diabetes mellitus
  • Glomerular disease
  • Tubular and interstitial diseases
  • Renovascular and other vascular diseases
  • Congenital, rare familial and metabolic disorders
  • Retransplant/graft failure

Additional pediatric indications include but are not limited to:

  • Symptoms of uremia not responsive to standard medical therapies
  • Failure to thrive due to limitations in total caloric intake
  • Delayed psychomotor development
  • Hypervolemia
  • Hyperkalemia
  • Metabolic bone disease due to renal osteodystrophy not responsive to standard medical therapies

Contraindications

Absolute Contraindications

Absolute contraindications for adults and children include, but may not be limited to:

  • Advanced cardiopulmonary disease
  • Active malignancy with the exception of skin cancer
  • Severe local or systemic infection
  • Severe neurologic deficits
  • Active substance addiction/abuse
  • Major psychiatric illness or active substance abuse that cannot be managed sufficiently to allow post-transplant care and safety

Absolute contraindications for children include, but may not be limited to:

  • HIV infection with viral load present
  • Chronic active infection with Hepatitis B
  • Severe multi-organ failure that precludes a combined transplant with a kidney

Relative Contraindications

Relative contraindications for adults and children include, but may not be limited to:

  • Advanced cardiopulmonary disease
  • Multiple urinary tract reconstructions
  • Lack of social support
  • Age greater than 75 years
  • Severe malnutrition/cachexia
  • Evidence of significant non-adherence
  • Cardiopulmonary disease
  • BMI 40 - 45 (See Obesity protocol for details)
  • Age less than 2 years or weight less than 10 kg

High Risk Factors

These factors are evaluated on a case-by-case basis and do not necessarily preclude transplantation.

  • Hepatitis
  • Small size
  • Complex genitourinary anomalies
  • Neurogenic bladder
  • Ileal loop
  • Multi-visceral transplant
  • Peripheral vascular disease
  • HIV – (adult only under strict protocol)
  • BMI greater than 35

Contact us for more information on kidney and pancreas transplants at Johns Hopkins.

 

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