Kidney transplantation is a surgical procedure in which a healthy, functioning kidney from a living or deceased donor, or a donor with brain death, is transplanted into a patient with end-stage chronic kidney disease to replace the lost kidney function.

Kidney transplantation is the best treatment for patients with end-stage chronic kidney disease, providing better quality of life and longer survival compared with dialysis.

 

What are the indications for kidney transplantation?

1. Patients with end-stage renal disease (ESRD) who have a glomerular filtration rate (GFR) of less than 15 mL/min/1.73 m² and are already receiving dialysis.
2. Pre-emptive kidney transplantation in patients with declining kidney function and a GFR below 20 mL/min/1.73 m² who have not yet started dialysis, or within 6 months after initiating dialysis. If a living donor is available, transplantation can be performed immediately and has been shown to provide better outcomes than transplantation after prolonged dialysis.
3. Re-transplantation when the first transplanted kidney fails. Patients may undergo a second kidney transplant after appropriate evaluation and preparation.

 

Who is not eligible for kidney transplantation?

Although kidney transplantation is the most effective treatment for chronic kidney failure, not all patients are suitable candidates. Patient safety during surgery and the long-term function of the transplanted kidney must be carefully considered. Contraindications to kidney transplantation are divided into two groups as follows:

 

1. Absolute contraindications

• Severe, uncontrolled infections, such as bloodstream infections or active tuberculosis under treatment
• Active malignancy or cancer with a high risk of recurrence
• Severe cardiovascular or pulmonary disease that makes surgery impossible or carries a very high risk of mortality
• End-stage liver cirrhosis
• Severe psychiatric disorders that prevent adequate self-care after surgery
• Ongoing substance abuse that cannot be discontinued
• Limited life expectancy due to severe comorbid conditions, where survival is not expected to be long enough to benefit from transplantation

2. Relative contraindications (require individual consideration)

These conditions may require postponing kidney transplantation until they are adequately treated or controlled:

• Severe obesity (BMI greater than 35 or 40 kg/m²)
• Heavy smoking
• Severe peripheral arterial disease
• History of recurrent thrombosis or coagulation disorders
• Uncontrolled hypertension
• Active peptic ulcer disease that has not yet healed
• Certain viral infections, such as hepatitis B or C with active severe liver inflammation, which must be treated until viral levels are adequately suppressed
• HIV infection was previously considered an absolute contraindication, but transplantation is now possible if viral load is very low and immune status is appropriate
• Poor dental health requiring dental clearance, including fillings or extraction of decayed teeth, prior to transplantation
• Urinary tract abnormalities, such as bladder dysfunction or kidney stones, which require corrective surgery before transplantation
• Very young or advanced age (physical fitness and overall health must be assessed on an individual basis)