TABLE 2.
Absolute and relative contraindications for potential recipients for LKD.
| Absolute |
| Medical |
| Cardiovascular* |
| Severe cardiac disease with uncorrectable symptoms (NYHA III/IV), |
| ventricular dysfunction (ejection fraction < 30%), severe valvular disease) |
| Pulmonary* |
| Severe irreversible obstructive or restrictive disease |
| Gastroenterological* |
| Acute decompensated liver cirrhosis** |
| Malignancy* |
| Active (except in situ/low grade carcinoma: e.g., prostate cancer with Gleason score < 6 or |
| incidental detected renal tumors < 1 cm max diameter) |
| In recent past medical history (only low-grade tumor at least 2 years low grade tumor without recurrence) |
| Multiple comorbidities§ |
| Neurological* |
| Progressive central neurodegenerative disease |
| Unstable psychiatric disorder* |
| Psychosocial |
| No meaningful relationship between donor and recipient |
| Coercion |
| Non-adherence |
| Uncertainty for transplantation |
| Relative |
| Medical |
| BMI > 35 kg/m2 (without weight loss) |
| Cardiovascular* |
| Active, symptomatic cardiac disease (unassessed) |
| Active, symptomatic peripheral arterial disease |
| Neurological* |
| Recent stroke or transient ischemic attack |
| Gastroenterological* |
| Active disease (e.g., peptic ulcers, acute pancreatitis, infections, uncontrolled inflammatory bowel disease, acute hepatitis) |
| Endocrinological* |
| Severe hyperparathyroidism (PTH > 800 pg/ml under conservative therapy and unsuitable for surgery) |
| Infectious disease (urinary tract infection, Anti-HCV positive) |
| Long dialysis vintage (over 8 years) |
| Stable kidney function (eGFR > 15 ml/min without worsening to RRT in 6 months) |
LKD, living kidney donation. *In all categories, the statement of an expert in the field (e.g., cardiologist, pulmonologist, oncologist) was included in the evaluation process. **Consider simultaneous liver-kidney transplantation. §Patients with at least three medical conditions in which at least one of them or de combination leads to a significant reduction of the patients’ survival as of Germany’s current standards. NYHA, New York, Heart Association (classification of symptomatic heart failure); BMI, body mass index; HIV, human immunodeficiency virus; PTH, parathormone; HCV, hepatitis C; eGFR, estimated glomerular filtration rate.