Preparing for Transplantation

Individuals with progressive advanced chronic kidney disease (CKD) have a number of treatment modalities to consider before reaching end-stage renal disease. As CKD reaches stage 4, and particularly as glomerular filtration rate approaches 20 mL/min, patients should be informed of kidney transplantation as a treatment option, provided education regarding the transplant process, and be referred to a transplant center unless there are clear contraindications or comorbidities that preclude consideration. There is an unfortunate and dramatic disparity between those who are eligible for transplantation and those who receive a transplant, due in part to referral biases, the comparative shortage of deceased donors, and a lack of acceptance or awareness of living kidney donation as an option. This chapter reviews the transplant landscape, discusses the procedural and pathophysiological considerations for kidney transplantation, and outlines the transplant evaluation process, including inclusion and exclusion criteria.