These decisions clearly require close discussions between recipient, donor, the treating transplant team and an selleck screening library oncologist. This guideline seeks to provide some suggestions for Nephrologists involved in advising patients with a prior malignancy on waiting times from successful treatment of malignancy to transplantation. Recommendations are difficult in this area given the lack of sufficient evidence. Most data are from reports on outcomes in less than 100 patients. These reports do not described the malignancies sufficiently in terms of staging or the range of waiting times observed from successful treatment until transplantation to be able to offer a stage
by stage suggestion as to waiting times. Therefore, this guideline along with other international guidelines has grouped malignancies together in offering suggestions for waiting times. These should be read in that light as it is likely that a lower grade/stage malignancy may require a shorter duration of waiting
than a more aggressive/advanced malignancy. Overall the suggestions are that in situ or pre-malignant conditions require minimal or no waiting time while for other cancers a 2- or 5-year AZD6738 ic50 wait has been suggested on the basis of the reported recurrence rates and associated mortality risks. The suggestions made are based on deceased donor transplant listing with the aim of achieving an 80% chance of 5-year survival although the data do not allow that degree of precision. In patients with a live donor a decision to proceed earlier may be made if all parties are agreeable after understanding the likely risks involved. We recommend that obesity should not on its own preclude
a patient from being considered for kidney transplantation (1B). As a pretransplant BMI (Body Mass Index) >40 kg/m2 may not be associated with a survival advantage compared to remaining on dialysis, we suggest that the suitability for transplant Liothyronine Sodium be carefully assessed on an individual basis (2C). As patient and graft survival of obese transplant recipients may be mediated by comorbid factors, particularly cardiovascular, we recommend that obese transplant candidates are screened for cardiovascular disease (refer to ‘Cardiovascular Disease’ sub-topic guidelines for recommendations) (1C). None. In the past, high BMI as a barrier for transplantation has tended to be a surgical issue. It was recognized as a problem by Starzl’s group in 1990. It appears, however, that there are also medical implications in terms of graft and patient loss. In the USA, nearly 58.8% of subjects at the time of transplantation currently are overweight or obese. Most studies are small, single-centre, control-matched comparisons, and therefore may not be particularly helpful. Some of the earlier studies used different immunosuppression regimens, to those used currently, which may also have an effect.