Suitability for transplantation

There is no upper age limit for transplantation

In essence there are three issues that need to be considered for anyone contemplating renal transplantation:

  • Suitability for general anaesthesia and surgery
  • Suitability specifically for kidney transplant surgery – from an anatomical, urological and vascular perspective
  • Suitability for long-term immunosuppression – in relation particularly to infection, malignancy and compliance

For further information please click here. There is no upper age limit for transplantation (the oldest person to receive a transplant in NI has been 78 years old), and it is commonly the constellation of health issues rather than one single contraindication that determines suitability. It is possible obviously for some risk factors to be successfully modified, such as obesity, glycaemic control, cigarette smoking etc. Transplantation is increasingly being offered to more ‘marginal’ candidates if they are accepting of the higher risk nature for themselves. For these individuals a living donor transplant has obvious advantages as it allows a planned elective procedure, with avoidance of further accumulation of disease on maintenance dialysis therapy while waiting for deceased donor offer.

Most people if they are suitable for transplantation will benefit in terms of survival compared to being on dialysis therapy, though clearly those who live longest are those who have minimal co-morbidities at the time of transplantation.

The ideal time for transplantation is before dialysis is necessary but some have an unavoidable delay e.g. on dual anti-platelet therapy following cardiac PCI, necessity for a disease-free period following malignancy.

For people who are never going to be suitable for transplantation then optimisation of dialysis is the key. Home haemodialysis therapy is encouraged and promoted for this group as it is associated with substantially improved long-term outcomes.