repeat transplantation. It is usually a good idea to let a period of time go by before re-evaluation. Such patients must have undergone a change in their situation such that they have insight into how their previous actions resulted in the loss of their previous transplant. For instance, it is not uncommon for teenage transplant recipients to lose a transplant due to non-adherence with their medications. Many of these patients become much more responsible as they grow up into adults. If the patient is medically stable, has good psychosocial support, and is expected to be adherent with their transplant regimen in the future, they may be considered for repeat transplantation. Smoking history Recent literature and clinical observations have linked chronic smoking to progression of atherosclerosis and renal disease in humans, which is worse among diabetics. Even the alternative use of electronic cigarettes or marijuana is associated with similar health risks. Smoking alone is associated with an increased risk of transplant rejection, as well as a decrease in transplant and patient survival. Most centers will strongly recommend tobacco cessation but may still consider smokers for transplant listing. Because of the increased health risk, diabetic patients who are actively smoking are likely to be denied access to renal transplantation. Health maintenance studies Most transplant centers follow national guidelines for disease prevention as established by consensus groups from the American College of Physicians, the Center for Disease Control and Prevention, and the American Society of Transplantation. Transplant candidates are required to follow some basic recommendations: 1. Recommended Vaccinations: Hepatitis B series, Pneumococcal vaccinations (both pneumococcal conjugate vaccine 13 and pneumococcal polysaccharide vaccine 23), Herpes Zoster, Tetanus with diphtheria, and for those who are not immune, hepatitis A. 2. Dental care: Recommend assessment by an oral health provider to assess for cavities and severe periodontal disease 3. Dermatology Screening: Basic screening to exclude skin cancer 4. Colonoscopy for patients over age 50 or who are at increased risk. 5. Females: Mammogram and Pap Smears as per standard guidelines 6. Males: Prostate examination and PSA as per standard guidelines 7. Cardiac Screening: 2D Echocardiogram, and Stress test or equivalent if clinically indicated (Cardiac testing practice varies by transplant center; some centers require cardiac testing to be done at the transplant center). Referral to multiple transplant centers Due to the size of the UNOS list and the lengthy waiting times to receive a deceased donor transplant, referring nephrologists and patients may consider multicenter referrals. According to UNOS guidelines, patients may be evaluated and listed at as many centers as they like. As long as the patient chooses to list at transplant centers which operate under different organ procurement organizations (OPOs), that practice may have a benefit, as the each OPO procures its own kidneys; multiple listing may therefore increase a patient’s chance of being offered a kidney. Living donation The number of patients on the kidney transplant waiting list continues to grow, but the number of deceased donors has been relatively unchanged. Most centers recommend that a potential candidate bring at least one family member to the transplant evaluation, to educate the family and other members [KIDNEY TRANSPLANT TOOLKIT] May 13, 2019 © Copyright, Forum of ESRD Networks, 2019 Page 9 of the patient’s support system about the benefits of living donation and the living donor evaluation process. Patients are strongly encouraged to seek out living donors, as living donor transplants have the best outcomes for transplant recipients. [KIDNEY TRANSPLANT TOOLKIT] May 13, 2019 © Copyright, Forum of ESRD Networks, 2019 Page 10 Chapter 2: Deceased Donor Transplantation, The Kidney Transplant Operation, and Transplant Complications Author: Ron Parsons, MD Kidney transplantation is the best available treatment for end-stage renal disease. A kidney from either a deceased or live donor has been shown in numerous studies to have superior patient survival rates, and improved quality of life, compared to dialysis therapy. Successful kidney transplantation requires finding a compatible donor, surviving an abdominal surgery, and maintaining successful levels of immune suppressing medication to avoid rejection. We will review these topics below. The five-year survival rate after deceased donor kidney transplantation is approximately 75%. Kidneys from living donors can be more quickly identified and transplanted than a deceased donor kidney. Wait time on average for a deceased donor kidney is approximately 5 years in the United States but is longer in many regions. Patients should be encouraged to actively seek live donors through discussion with family and friends, as these individuals are most likely to donate. Please see the Living Donor Transplant chapter for details on this process. The successful outcome of a deceased donor renal transplant requires that both the donor and the recipient have undergone adequate evaluation and selection. These processes strive to identify which organs and which patients will be best suited for the endeavor of transplantation. Recipient Selection Patients who undergo