cardiogram (ECG) □ Ultrasonographic cardiogram (UCG) □ Myocardial scintigraphy if known heart condition, diabetes, smoker, long-term dialysis or hypertension, family history or >50 years old □ Coronary angiography, if myocardial scintigraphy showed reversible ischemia □ Chest X-ray (within 12 months) □ Cardiology consultation □ Dentist (prevention of dental or oral infection) □ Vaccination against pneumococci □ Current list of medication Practical Protocols for Living Donor Kidney Transplantation 16 Kidney Recipient Work Up Check List for Referral Name and date of birth of patient: Summary and evaluation of the recipient work up findings: 1. Cardiac evaluation: a standard work up includes ECG and UCG; in case of diabetes, long-term history of smoking, known cardiovascular disease or age >60 years, extended work up including myocardial scintigraphy, coronary angiography and cardiologist consultation may be done. □ Standard work up was done and no significant pathology found □ Extended work up was done 2. Parathyroid function: P-PTH, calcium and phosphate should be evaluated for any suspicion of secondary/tertiary hyperparathyroidism and indication for parathyroidectomy. Operation should be performed before kidney transplantationNo suspicion of secondary/tertiary hyperparathyroidism □ There is a suspicion and further treatment / operation is planned 3. Glucose tolerance: patients who do not have diabetes should be tested with an oral glucose tolerance test (OGTT). If they have reduced glucose tolerance, steroid-free immunosuppression should be considered □ Known reduced glucose tolerance (e.g. on a dietOGTT showed reduced glucose tolerance OGTT was normal 4. APC-resistance: if the test for APC resistance was positive, the patient should have prolonged prophylaxis of thrombosis. □ No APC resistance□ APC resistance 5. PRA: the presence of HLA antibodies should be tested with both cytotoxic and flow cytometric tests. Presence of HLA antibodies might influence the choice of immunosuppression. □ PRA cytotoxicity test done and negative □ PRA flow cytometry test done and negative One or both of the two tests was positive 6. Dentist: the recipient should go to the dentist for an examination and treatment of any teeth that may have an increased risk of infection. □ Dentist examination is done 7. Antibody screening: for HIV, HBsAg, HepBcAb, HepBsAb, hepatitis C (and hepatitis C PCR, if HCV positive), syphilis, CMV, varicella zoster, herpes simplex, and Epstein-Barr. Screen for latent tuberculosis and give appropriate treatment to infected patients. □ Tuberculosis HIV, syphilis, hepatitis B and C done and negative □ CMV, VZV, HSV, EBV done 17 8. Vaccination: patients should be vaccinated before transplantation (if not done previously) for polio, hepatitis A, tetanus, diphtheria, mumps, measles, rubella, hepatitis B, pneumococcus, influenza, meningococcus, VZV, and hemophilus influenza B. □ Vaccinations considered and done 9. Computerized Tomography without contrast medium: extensive calcifications of the iliac arteries might make the operative procedure difficult or impossible. In patients with known or suspected vascular disease a CT of iliac arteries should be donesignature: Practical Protocols for Living Donor Kidney Transplantation 18 2. Living Donor Work Up General strategy and objectives 1. The family of the recipient is informed about the possibility of living donation. 2. Meet potential donors individually and perform psycho-social evaluation. Potential donors must be given time to decide, and it must be a truly voluntary decision. 3. Undertake medical work up and evaluation concerning operative risk (cardiovascular and pulmonary). 4. Undertake nephrological evaluation concerning long-term risk after unilateral nephrectomy (hereditary for kidney disease, current GFR, risk factors for kidney disease). 5. The living donor work up should be performed by a different nephrologist than the one responsible for the recipient. Before the living donor work up is started, the recipient should be evaluated and accepted as a future candidate for kidney transplantation. Primary work up Step 1: –Identify potential living donors –Hand out written information about donation (Protocol 19) –Perform blood group test Step 2: –Potential donor visits with nephrologist for oral information and physical examination plus ECG. –Donor visits with social worker (experienced in LD) –Collect blood and urine samples according to the check list; include tissue typing, cross match no. 1 and FACS cross match. Perform ultrasound of kidneys. Step 3: –The nephrologist responsible for the donor makes a summary of the visits to the physician and social worker, the results of the blood and urine tests and ECG. The potential donor(s) are informed about the work up thus far and told if the work up will continue or be stopped at this point. If there are several potential living donors, one is chosen for further work up. Secondary work up Step 4: –Order continued work up according to the check list, with additional examinations if indicated. CT angiography of renal arteries to be done early. Step 5: –Donor visits responsible nephrologist for summary of results. –Donor visits social worker for the second time. –Donor receives a referral to the transplant surgeon with a 19 summary report on the work up and copies of all