Management of the Waiting List for Cadaveric Kidney Transplants

The Clinical Practice Guidelines Committee of the American Society of Transplantation developed a survey to review the policies of kidney transplant programs in the United States with respect to the management of the steadily expanding waiting list for cadaveric kidneys. The survey was sent to 287 centers, and 192 (67%) responded. The survey indicated that regular follow-up monitoring, most frequently on an annual basis, is required by the majority (71%) of programs. Patients considered to be at high risk and candidates for combined kidney-pancreas transplantation may be monitored more frequently. Annual screening for coronary artery disease is typically required for asymptomatic patients considered to be at high risk for covert disease. Noninvasive techniques are typically used, and a designated cardiologist is usually available to the transplant program. The dialysis nephrologist or the potential transplant recipient is expected to inform the transplant program of intercurrent events that may affect transplant candidacy. Standard health maintenance screening is required, together with the routine updating of serologic and other blood tests that may be relevant to the posttransplant course. Smaller transplant programs (<100 patients on the waiting list) are more likely to maintain closer contact with the wait-listed patients and to attempt to influence their treatment during dialysis and are less likely to cancel transplants because of unanticipated pretransplant medical problems. The work load necessitated by the follow-up monitoring of wait-listed patients was assessed and, in the absence of specific evidence-based information, a series of recommendations were developed to reflect current standards of practice and to suggest future research initiatives.