THE EVALUATION OF CANDIDATES FOR RENAL-TRANSPLANTATION - THE CURRENT PRACTICE OF US TRANSPLANT CENTERS

The criteria for acceptance of candidates for renal transplantation va ries throughout the United States. The Patient Care and Education Comm ittee of the American Society of Transplant Physicians conducted a sur vey of all U.S. centers that participate in the United Network for Org an Sharing (UNOS) concerning their evaluation of adult candidates for kidney transplantation. The response to each question was examined acc ording to the specialty of the individual who filled out the questionn aire, as well as the type of transplant center (university or private) and the size of the center. The response rate to the survey was 81% ( 147/182). We found the following: (1) university-based and larger cent ers accepted more medically complicated patients; (2) 83% noted that a ttendance to dialysis was an important indicator of compliance after t ransplantation; (3) 79% did not require preoperative blood transfusion s for cadaver kidney recipients; (4) 66% set no specific upper age lim it for transplantation; (5) 66% excluded patients with chronic active hepatitis in the setting of hepatitis B antigenemia; (6) 50% had no sp ecific policy for evaluating hepatitis C antibody-positive patients, w hile 54% excluded the use of hepatitis C antibody-positive donors, and (7) 15% obtained coronary angiography on all diabetic patients. U.S. transplant centers have a heterogeneous approach to the evaluation of patients for renal transplantation, particularly in the areas of viral hepatitis, cardiovascular disease, and noncompliance. University-base d centers and centers that perform a larger number of transplants acce pt more medically complicated patients.