What are the key pre-operative assessments required for a patient being considered for kidney transplantation?

Key pre-operative assessments for a patient being considered for kidney transplantation include:

• Comprehensive clinical assessment: This involves evaluating the patient’s overall health status, including co-existing conditions, to inform the risks and benefits of transplantation and to support shared decision-making with the patient and their family or carers ¹.
• Psychosocial evaluation: Assess for risk factors that may affect transplant outcomes such as lack of social support, neurocognitive issues, non-adherence to treatment, poor understanding of the transplant process, mental health conditions, and substance misuse. Referral to a clinical psychologist or psychiatrist should be considered if these risks are identified ¹.
• Timing of assessment: Begin assessment for renal replacement therapy including transplantation at least one year before therapy is likely to be needed to allow adequate preparation and decision-making ¹.
• Risk assessment for acute kidney injury and surgical risks: Evaluate risks related to surgery, including factors such as chronic kidney disease severity, diabetes, heart failure, age over 65, liver disease, and use of nephrotoxic drugs, to inform perioperative management plans ³.
• Shared decision-making and patient education: Engage the patient and their family in discussions about treatment options, including living donor transplantation, and provide high-quality information and education tailored to their condition and preferences ¹,².