• Indications
• Contraindications
• High Risk Factors

Indications

Any condition that results in end-stage renal disease (defined: GFR<15 (stage V CKD); GFR<20 for DDRT (stage IV CKD); Recipients with living donors may have GFR 20-30 (stage IV CKD)) including, but not limited to:

• Diabetes mellitus
• Glomerular disease
• Tubular and interstitial diseases
• Renovascular and other vascular diseases
• Congenital, rare familial and metabolic disorders
• Retransplant/graft failure

Additional pediatric indications include but are not limited to:

• Symptoms of uremia not responsive to standard medical therapies
• Failure to thrive due to limitations in total caloric intake
• Delayed psychomotor development
• Hypervolemia
• Hyperkalemia
• Metabolic bone disease due to renal osteodystrophy not responsive to standard medical therapies

Contraindications

Absolute Contraindications

Absolute contraindications for adults and children include, but may not be limited to:

• Advanced cardiopulmonary disease
• Active malignancy with the exception of skin cancer
• Severe local or systemic infection
• Severe neurologic deficits
• Active substance addiction/abuse
• Major psychiatric illness or active substance abuse that cannot be managed sufficiently to allow post-transplant care and safety

Absolute contraindications for children include, but may not be limited to:

• HIV infection with viral load present
• Chronic active infection with Hepatitis B
• Severe multi-organ failure that precludes a combined transplant with a kidney

Relative Contraindications

Relative contraindications for adults and children include, but may not be limited to:

• Advanced cardiopulmonary disease
• Multiple urinary tract reconstructions
• Lack of social support
• Age greater than 75 years
• Severe malnutrition/cachexia
• Evidence of significant non-adherence
• Cardiopulmonary disease
• BMI 40 - 45 (See Obesity protocol for details)
• Age less than 2 years or weight less than 10 kg

High Risk Factors

These factors are evaluated on a case-by-case basis and do not necessarily preclude transplantation.

• Hepatitis
• Small size
• Complex genitourinary anomalies
• Neurogenic bladder
• Ileal loop
• Multi-visceral transplant
• Peripheral vascular disease
• HIV – (adult only under strict protocol)
• BMI greater than 35