Indications for Pretransplantation Native Nephrectomy

 Chronic renal parenchymal infection

 Infected stones
 Heavy proteinuria
 Intractable hypertension
 Polycystic kidney disease*
 Acquired renal cystic disease†
 Infected reflux‡
*Only when the kidneys are massive, recurrently infected, or bleeding.
†When there is suspicion of adenocarcinoma.
‡Uninfected reflux does not require nephrectomy.

Other indications for native nephrectomy include solid kidney tumors, upper tract urothelial
tumors, hypertension refractory to medical therapy, severe, intractable nephrotic
syndrome, cystic kidney disease causing loss of abdominal domain, pain or anorexia,
and high volume stone disease not amenable to endoscopic treatment

ALLOGRAFT NEPHRECTOMY
Indications
Kidneys that have failed either for technical reasons or because of rejection may need to be
removed. Indications for allograft nephrectomy are symptoms and signs that typically occur
when immunosuppression is withdrawn but may be delayed by weeks or months. These can
include low-grade fever, graft tenderness, and hematuria. It may be possible to lessen the
symptoms and avoid nephrectomy by temporary reinstitution of steroids. Avoidance of
nephrectomy is preferred because the procedure can result in significant morbidity and may
cause a steep elevation in the percentage of preformed cytotoxic antibodies affecting future
transplantations. If the graft loss is acute and occurs within 1 year of transplantation,
nephrectomy is necessary in most cases. Graft loss from chronic rejection after 1 year may not
require nephrectomy. The rejected graft that remains in situ typically becomes a small, fibrotic
mass. Acquired cystic disease may develop as described in chronically diseased native kidneys
Major Contraindications to Kidney Transplantation
w Recent or metastatic malignancy*
w Untreated current infection
w Severe irreversible extrarenal disease
w Recalcitrant treatment nonadherence
w Psychiatric illness impairing consent and adherence
w Current recreational drug abuse
w Aggressive recurrent native kidney disease
w Limited, irreversible rehabilitative potential
w Primary oxalosis

Contraindications to Living Kidney Donation*

Absolute Contraindications
w Evidence of renal disease (glomerular filtration rate < 80 mL/min, microalbuminuria
or overt proteinuria)
w Significant renal or urologic abnormalities
w Transmissible infectious disease (HIV infection, hepatitis B, hepatitis C)
w Active malignancy
w Chronic illness that places patient at significant risk to undergo surgery
w Poorly controlled psychiatric illness or active substance use
w Cognitive deficit
w Current pregnancy
w Hypertension, uncontrolled or requiring multiple medications
w Diabetes mellitus
w Recurrent nephrolithiasis or bilateral stones
w History of thrombotic disorders with risk factors for future events or inherited
hypercoagulable states†

Relative Contraindications
w Age < 18 or > 65 years
w Borderline or mild hypertension (see text)
w Borderline urinary abnormalities in the absence of renal function impairment
w Single prior episode of nephrolithiasis without evidence of secondary risk
w Obesity
w Young donor with risk factors for future development of diabetes mellitus (see text)
w Jehovah’s Witness patient
*Criteria may differ among transplantation centers.