ABSTRACT
Indications and contraindications to transplantation 743 Donor source 744 Organ procurement and allocation for children 744 Immunologic barriers to transplantation 745 Immunobiology of allograft rejection 747 Immunosupressive therapies 749 Pretransplant evaluation of recipient 752 Donor evaluation 754
Surgical procedure 754 Perioperative transplant management 755 Transplantation in highly sensitized recipients 757 Complications of transplantation 757 Nonadherance in transplantation 767 Transition of care 767 References 769 Answer key 773
Table 38.1 Contraindications to renal transplantation in children
Absolute Contraindications • Acute infection • Untreated malignancy • Oxalosis and other genetic syndromes that might
benefit from a combined liver and kidney transplant • Life-limiting coexisting medical conditions: Advanced
cardiac, pulmonary, neurologic, or other systemic disease
• Multiorgan failure • Progressive neurologic illness • Pregnancy
Relative Contraindications • Uncontrolled HIV infection • Untreated hepatitis C infection • Untreated hepatitis B infection • MAI, BKV, and other infections • Ventilator dependent children*
• Recurrent FSGS in previous transplant • Active immune-mediated glomerulonephritis (SLE,
Good-Pasteur’s syndrome, ANCA-associated GN) • Persistent vegetative state* • Extreme obesity and malnutrition • Psychosocial concerns, including poor adherence
with medical regimen
A number of immunologic barriers to successful transplantation exist, of which the most important are blood group antigens, HLA mismatches and preexisting anti-HLA antibodies before transplant, and development of de novo donor-specic antibodies (DSA) following transplant.19
