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, David Rush, 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, 24 921 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 it prolongs 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 not known 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 in determining 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 auniversally funded health care system. Health care coverage or insurance should not be an issue in determining transplantation eligibility in Canada as it may be in other regions of the world.10 The methods used to develop these guidelines were designed to ensure that the recommendations reflect a Canadian consensus so that they would be adopted across the country. These guidelines are based on the bestavailable evidence. However, clinical judgment plays a role in decision-making and, thus, there will still be variability in clinical practice across the country. This consensus document specifically addresses eligibility criteria for kidney transplantation and is not meant to outline the individual tests required for assessment or reassessment of patients awaiting kidney transplantation. Publishedclinical practice guidelines from the United States and Europe already exist in this area.10–12 These guidelines were developed with a wide audience in

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mind. General recommendations are provided in summary form for review by health care workers and physicians working in primary care, who may want to know whether their patient with ESRD is eligible for transplantation. We also expand on therecommendations for those interested in more detail. The guidelines refer to both children and adults and, as such, will be of interest to health care workers and physicians treating either age group.

Methods
The Kidney Transplant Working Group, a subcommittee of the Canadian Society of Transplantation (CST), was asked to prepare eligibility criteria for renal transplantation by the CSTpresident and the Executive Council. Dr. E. Cole, the chair of the Kidney Transplant Working Group, appointed a guidelines steering committee made up of 7 other physicians from the working group (the authors of this article) based on geographic representation (British Columbia, Alberta, Manitoba, Ontario, Quebec, Atlantic Provinces) as well as specialty (adult and pediatric nephrology). The chair and...