Pre-transplant management by nephrologists

a key to greater success in kidney transplantation

Abstract

Kidney transplantation (KTx) is the best option of renal replacement therapy (RRT) in terms of the prognosis of patients with end stage kidney disease (ESKD). The success in KTx requires the multidisciplinary medical approaches, such as management of complications with ESKD, infection control, and cardiovascular management, and it has been emphasized recently in Japan that nephrologists should be as much involved in KTx as in hemodialysis and peritoneal dialysis. Kidney Disease Improving Global Outcomes (KDIGO) and Japanese Society for Clinical Renal Transplantation established the clinical practice guidelines for KTx in 2007 and 2011, respectively, and these guidelines extensively describe post-transplant care for kidney transplant recipients. However, they do not refer to the pre-transplant management. There is some good evidence to suggest pre-transplant care may be associated with better KTx patient outcomes. The preparation for KTx should start from the time of recognition of chronic kidney disease (CKD), and should occur in parallel with efforts to prevent and delay its progression. This review focuses on pre-transplant management for KTx from the standpoint of nephrologists; ① Pre-transplant management of renal failure/dialysis ② Pre-transplant infection control (pre-transplant vaccination) ③ Pre-transplant diagnosis of native kidney disease. The pre-transplant care by nephrologists, who have seen CKD patients longer before KTx than transplant surgeons, is an important key to greater success in KTx.