The evaluation of kidney transplant candidates prior to waitlisting: a scoping review

Background
Before patients with kidney failure can undergo kidney transplantation, their suitability is assessed through a transplantation work-up. Variation in the transplantation work-up could contribute to inefficiency and inequality in accessing the transplant waiting list and kidney transplantation. We conducted a scoping review on the evaluation of kidney transplant candidates prior to waitlisting, investigating: (a) content of the transplantation work-up; (b) contraindications to waitlisting; and (c) organization of the transplantation work-up.

Methods
A systematic search was conducted in Ovid Medline and Ovid EMBASE in collaboration with a medical information specialist. Studies investigating practice patterns since 2013 related to the evaluation of adults receiving their first kidney graft from a deceased donor were included.

Results
Results from 20 studies showed substantial variation in the evaluation of kidney transplant candidates. The content of the transplantation work-up differed between studied centers, yet common domains included screening for infections, heart disease, peripheral artery disease, and malignancy. Commonly reported contraindications to waitlisting were obesity and age-related factors. However, strict cut-off for BMI and age were used less. The organization of the transplantation work-up differed across studied centers with regard to referral and waitlisting decisions, screening and prioritization, and the setting of the transplantation work-up.

Conclusions
Literature on the evaluation of kidney transplant candidates is limited, but our findings suggest substantial variation in pre-waitlisting practices among centers. This may contribute to differences in kidney transplantation access and outcomes between countries. Further research on pre-transplantation practices, specifically regarding the standardization of the transplantation work-up, is needed.