Practice

Renal transplantation in adults

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6158 (Published 30 November 2016) Cite this as: BMJ 2016;355:i6158
  1. Tom Nieto, clinical research fellow1,
  2. Nicholas Inston, consultant renal surgeon1,
  3. Paul Cockwell, consultant nephrologist1
  1. 1Renal Services, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
  1. Correspondence to: T Nieto t.nieto{at}bham.ac.uk

What you need to know

  • Renal transplantation is the treatment of choice for many patients with end stage renal failure

  • Accurate immunosuppression management is critical to maintain long term transplant function and minimise complications

  • There is an increased risk of infections and cancer, and both can progress rapidly as patients are immunosuppressed

Renal transplantation improves quantity and quality of life compared with chronic dialysis.1 2 3 A UK general practice with 8000 patients will have around four patients with a functioning renal transplant, one patient on the transplant waiting list, and several under consideration for transplantation.4 Many medical problems in renal transplant recipients will be managed by non-specialist clinicians, and this article provides advice for the non-specialist on managing renal transplant patients.

Where do donor kidneys come from?

Kidneys are transplanted following donation after brain stem death or after circulatory death and living donation. In the UK, the renal transplant surgical team is informed by NHS Blood and Transplant (NHSBT) when a deceased donor kidney becomes available for a patient on the renal transplant waiting list (fig 1).

Fig 1 Classification of renal transplant operations in the UK

Allocation is based on a scoring system that includes immunological compatibility, recipient age, donor-recipient age parity, and time on waiting list.5 The median waiting time for a deceased donor transplant in the UK is two years and eight months, and this varies between centres.6 There are major international differences in donation and transplantation rates.7

Living donation is from a willing individual usually with a close emotional relationship with the recipient, although altruistic living donation is increasing.8 In a study of 36 UK patients who travelled overseas for commercial living donation transplantation, their clinical outcomes were significantly worse than those of 40 matched patients who received living donor transplants at their UK centre (composite graft and …

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