Relative contraindication
Disseminated malignancyExtensive vascular diseaseHigh risk for perioperative mortalityPersistent coagulation abnormalityRenal disease with high recurrence rateRefractory noncomplianceUrologic abnormalitiesActive systemic illnessOngoing substance abuseUncontrolled psychosis
Age
The very young patient (<5 years) and the elderly recipient do have a poorer patient and graft survival than patients of ages between these two extremes. However, with the improvements in perioperative management and immuno suppressive strategies, advanced age itself is no longer a contraindication
Obesity
Obesity alone is rarely an absolute contraindication to transplantation, yet it is a well-defined risk factor.
Lower graft survival rates as well as higher postoperative mortalities and complications have been demonstrated in patients with a body mass index (BMI) greater than 30 kg/m2.
The large body size is also a risk factor for progression and subsequent premature failure, due to the physiologic changes that have been linked to nephron hyperfiltration.
weight reduction is important for an obese dialysis patient before proceeding to transplantation.
Prior Kidney Transplantation
Renal allograft failure is now one of the most common causes of ESRD, accounting for about 30% of patients awaiting renal transplantation.
Graft survival of a second and/or third kidney transplant has been reported to be inferior to that of the first.
Evaluation of a potential recipient for a second or third allograft requires careful attention to the reason for the graft failure.
Factors to be assessed include
noncompliance with immunosuppressive medicationsloss of the graft in association with recurrent renal diseasehigh alloreactivity with high panel-reactive antibody (PRA) titers (PRA).
These patients may also manifest complications of prior immunosuppressive therapy, and as such should be screened for complications associated with these medications (e.g. infection and malignancy).