Guias canadienses para trasplante renal

Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation
Greg Knoll, Sandra Cockfield, Tom Blydt-Hansen,Dana Baran, Bryce Kiberd, David Landsberg, DavidRush, Edward Cole, for the Kidney Transplant Working Group of the Canadian Society of Transplantation
ince 1980, the incidence and prevalence of end-stage renal disease (ESRD) have increased each yearin Canada and throughout the world.1,2 From 1981 to 1999, the number of new patients with ESRD grew at a compound annual rate of 7.3%1 and similar trends were documented worldwide.2 By 31 Dec. 2000, 24921 Canadians were receiving life-sustaining treatment for ESRD; dialysis was the treatment modality for 14 567 patients and the remaining 10 354 patients (41.5%) had a functioning kidneytransplant.3 The development of ESRD is associated with a substantial reduction in health-related quality of life4,5 and premature death.6 Kidney transplantation is the treatment of choice for ESRD as itprolongs survival,7 improves quality of life4,5 and is less costly than dialysis.4 Despite the benefits of kidney transplantation, not all patients with ESRD take this route and there is considerablevariation in transplantation rates across Canada; for example, the renal transplantation rate (per million population) is only 27.4 in Saskatchewan compared with 51.8 in the Atlantic provinces.3 It is notknown to what extent this variation is due to differences in rates of referral and acceptance for transplantation (i.e., perceived eligibility) or to differences in availability of donors. The purposeof this consensus document was to outline which patients, in the growing Canadian ESRD population, are currently eligible for transplantation. We hope that these guidelines will lead to consistency indetermining which patients are eligible and accepted for kidney transplantation. Canadian patients with ESRD comprise a unique mixture including minority groups8,9 who receive treatment in a...