Evaluation of donor & recipients & Allocation Flashcards
Acceptable GFR for kidney donation
Acceptable: GFR > 90
May use: GFR 60 – 89
Contraindicated: GFR < 60
Acceptable BP for kidney donation
< 140/90 on 1 or 2 antihypertensive rx w/o evidence of end-organ damage
Acceptable DM status for kidney donation
T1DM cannot donate, T2DM or pre-diabetics on case by case basis
Acceptable albuminuria for kidney donation
Acceptable: Urine AER less than 30 mg/d
Contraindicated: > 100 mg/d
Kidney txp: when to refer for evaluation
GFR < 30 and expected to reach ESRD
Absolute C/I to kidney transplant
- Reversible renal failure
- Severe irreversible extrarenal dz
- Active infxn
- Active or untreatable malignancy
- Primary oxalosis
- Life expectancy <2 years
- Limited irreversible rehabilitative potential
- Poorly controlled psych illness
- Active illicit drug abuse
- Ongoing nonadherence
Frailty assessment tools
Liver txp: Liver Frailty Index
Geriatric populations: Fried Frailty Phenotype
Liver txp: indications for listing
Severe acute liver dz or ESLD w/ exhaustion of medication therapies + index complication (ascites, HE, etc)
Absolute C/I to liver transplant
- MELD < 15
- Severe cardiac/pulmonary dz
- Fulminant hepatic failure with sustain ICP > 50 or CPP < 40
- Active extrahepatic malignancy
- Intrahepatic cholangiocarcinoma
- Active, controlled infxn outside HB system
- Active substance abuse
- Technical/anastomical barriers
- Lack of adequate social support
- Persistant noncompliance
Panc txp: indications for listing
- T1DM or T2DM (no longer req to meet C peptide or BMI criteria)
- Pancreatic exocrine insufficiency (pancreatectomy, CF)
- Req of procurement of txp for part of mult-organ txp for technical reasons
Kidney-Panc txp: indications for listing
- DM or pancreatic exocrine insuff
2. GFR < 20
Intestinal txp: who to refer for evaluation
PN Failure:
- Impending or apparently liver failure 2/2 PN
- CVC-related thrombosis of 2 central veins
- Frequent central line sepsis: 2 episodes/year of systemic sepsis OR single episode of fungemia/septic shock/ARDS
- Frequent episodes of severe dehydration despite IVF
Desmoid tumors
Congenital mucosal disorders
Ultrashort bowel syndrome
Intestinal failure with high morbidity or inability to function
Patient unwillingness to accept long-term PN
Heart txp: indications for listing
Refractory AHA Stage D or NYHA Class III-IV Heart Failure
Malignancy ventricular arrhythmias unresponsive to standard therapies
Absolute C/I to heart transplant
- Irreversible pulm HTN
- Chronic noncardiac illness that compromisess urvival
- Severe PAD
- Active or recent malignancy
- Active infection
- Ongoing substance abuse
- Noncompliance
- Psych instability
- Poor DM control
Lung txp: indications for listing
- Obstructive dz: COPD, emphysema, bronchiectasis
- Pulm vascular dz : pulm HTN
- CF or immunodeficiency disorders
- Restrictive lung dz: IPF, retransplant
Absolute C/I to lung transplant
- Malignancy in the last 5 years (or 2 years if low risk)
- Multi-organ dysfunction
- Uncorrected atherosclerotic dz with end organ ischemia or CAD
- Acute medical instability: infxn or otherwise
- Uncorrectable bleeding diathesis
- Chronic infxn with highly virulent microbes
- Active TB infxn
- Significant chest wall or spinal deformity
- Current or hx of nonadherence
- Psych instability
- Lack social support
- Severe limited functional status
- Substance abuse
Kidney Txp: Dual antiplatelet therapy recommendations
Rec’d to delay txp for the mandated period
of treatment with DAPT when the risk of stopping medication (eg, stent thrombosis) or operating while on treatment (eg, surgical bleeding)
exceeds the anticipated benefit of transplantation
IF living donor: antiplatelets should be stopped 5 days prior to txp
Kidney Txp: Time to wait after stroke/TIA
Stroke: 6 mo
TIA: 3 mo
Kidney Txp: When to hold warfarin pre-txp
Living donor: 5 days
Islet cell txp candidates
- T1DM c/b hypoglycemia unawareness, severe hypoglycemia episodes, or glycemia liability
- Chronic pancreatitis with total pancreatectomy
Patients who should not be considered for islet cell
- T1DM <5 years
- Age 18+
- BMI > 30
- Weight > 90 Kg
- Daily insulin req >1 u/kg
Intestinal Organ Allocation Statuses
Status 1: LFT abnormalities, loss of vascular access, or urgent need
Status 2: all others
