Intended for healthcare professionals

Clinical Review

Renal transplantation

BMJ 2011; 343 doi: (Published 14 November 2011) Cite this as: BMJ 2011;343:d7300
  1. Paul T R Thiruchelvam, specialist registrar general surgery1,
  2. Michelle Willicombe, specialist registrar nephrology2,
  3. Nadey Hakim, surgical director department of transplant surgery2,
  4. David Taube, professor of transplant medicine2,
  5. Vassilios Papalois, consultant transplant and general surgeon, chief of service2
  1. 1North West Thames, Department of Transplant Surgery, Imperial College Renal and Transplant Centre, Hammersmith Hospital, London W12 0NN, UK
  2. 2Imperial College Renal and Transplant Centre, Hammersmith Hospital, London
  1. Correspondence to: P T R Thiruchelvam paul.thiruchelvam{at}
  • Accepted 31 October 2011

Summary points

  • The global burden of end stage renal disease is increasing

  • Renal transplantation increases patient survival and quality of life and reduces costs of care for patients with end stage renal disease

  • Most donor kidneys come from “brain death” or “cardiac death” donors, but donations from living donors are increasing

  • Pre-emptive transplantation from a living donor is the best treatment choice for patients with end stage renal disease and has been associated with improved allograft and patient survival

  • Long term outcomes in kidney transplantation are improving

Epidemiological data from the past decade suggest that the global burden of patients with renal failure who receive renal replacement therapy exceeds 1.4 million and that this figure is growing by about 8% a year.1 2 The UK renal registry from 2009 estimated that over 47 000 people received renal replacement therapy in the UK.3 Renal transplantation increases survival and improves the quality of life for patients with end stage renal failure.4 5 A recent UK estimate found that transplantation conferred a cost saving of £25 000 (€29 000; $40 000) a year per patient with end stage renal failure.6 In the UK rates of renal transplantation are increasing (fig 1), and since 2006 the number of patients waiting more than five years for a transplant has halved, but there are still a large number (about 7000) of patients on the transplant waiting list (fig 1).7 8

Fig 1 Deceased donor kidney programme in the UK, 1 April 2000-31 March 2010. Number of donors, transplants and patients on the active transplant list at 31 March.

We review the process of selecting patients eligible for renal transplantation and the care of patients after renal transplantation for the primary care physician. This article is based on evidence from large registries, case series, clinical …

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