Renal Transplant Evaluation
Transplant work-up assesses whether a patient with end-stage kidney disease can safely receive and keep a graft — screening cardiovascular fitness, infection/malignancy, immunological matching (blood group, HLA, crossmatch) and the urological tract, while the urologist focuses on bladder function and outflow.
The big picture
Transplantation is the best treatment for most end-stage kidney disease, but candidates must be fit enough for surgery and lifelong immunosuppression, free of active infection or untreated malignancy, and immunologically matched to a donor. The recipient assessment is multidisciplinary; the urological component centres on the bladder and outflow tract, native kidney issues (recurrent infection, stones, reflux, tumours), and vascular access for the graft.
Match the patient and the donor (ABO, HLA, crossmatch) AND make the lower urinary tract safe — a hostile bladder or untreated outflow obstruction will damage the graft.
Red flags
Optimise/augment before transplant — a hostile bladder damages the graft.
Contraindication to that donor without desensitisation; seek an alternative.
Must be cleared before immunosuppression and transplantation.
Symptom sorter
Can they survive surgery + immunosuppression?
Diagnostic algorithm
Each step answers one question. Tap to expand.
Treatment ladder
Select and prepare carefully: confirm fitness and matching, and make the urinary tract safe for the graft before transplantation.
Complications
- Graft loss if transplanted onto a hostile/obstructed lower tract
- Disease recurrence in the graft
- Native nephrectomy/augmentation surgical risks
- Immunosuppression-related infection/malignancy
- Thorough urological assessment and tract optimisation; careful matching and screening
- Treat the specific deficiency before transplant; lifelong post-transplant surveillance
Summary tables
Transplant evaluation domains
| Domain | Key checks |
|---|---|
| Medical fitness | Cardiac risk, infection/malignancy screen |
| Immunology | ABO, HLA typing, crossmatch |
| Urology | Bladder capacity/compliance/emptying; outflow |
| Native kidneys | Nephrectomy for infection/stones/PKD/tumour/reflux |
Memory hooks
Fit + matched + safe lower tract.
Immunology: ABO, HLA, crossmatch.
Positive crossmatch = no go for that donor.
Don't forget the bladder — it can kill a graft.
Board traps
Hostile/neuropathic bladder transplanted without optimisation → graft damage.
Positive crossmatch ignored.
Routine native nephrectomy for everyone (it is selective).
Clinical cases
A man with end-stage kidney disease from posterior urethral valves is being assessed for transplant. He has a small, poorly compliant, high-pressure bladder.
What urological step is essential before transplantation?