Transplantation is the kidney replacement therapy of choice for suitable patients with kidney failure. However, not all patients are suitable candidates for transplantation, and suitability is often determined by the perceived risks of transplantation relative to the risks of not receiving a transplant. Estimation of risk is therefore a key part of the transplant candidate evaluation. Should a decision to proceed to transplantation be made, consideration of how to minimize risks and maximize the chances of a successful outcome are additional aspects of the candidate evaluation process.
The KDIGO Clinical Practice Guideline for the Evaluation and Management of Candidates for Kidney Transplantation systematically examines current evidence concerning the risks of transplantation associated with specific conditions and provides recommendations as to how clinicians may wish to deal with specific risk factors in isolation. In practice, patients are frequently complex and exhibit multiple risk factors for poor transplant outcomes. Ultimately the clinician will be required to synthesize the total risk burden that each candidate presents in deciding on suitability for transplantation.