ABSTRACT
Absolute contraindications to renal transplantation are active infection, including human immunodeficiency virus and active malignancy. Bilateral native nephrectomies, once standard practice, are seldom required prior to renal transplantation. The potential renal donor must have no conditions that could increase the risk of postoperative complication, diminish the function of their remaining solitary kidney, or change their quality of life. The most difficult time of management for the potential deceased donor is that during the aggressive neurologic management prior to being declared as an irreversible, brain-dead patient. Immunosuppressive agents are utilized to prevent allograft rejection. They can be used as an induction agent immediately after allograft implantation, as maintenance immunotherapy once serum creatinine has normalized, or as treatment of acute rejection. Hyperacute rejection is a devastating and irreversible form of rejection that occurs within minutes to a few hours of allograft implantation. More than 80% of patients undergoing renal transplantation have at least one episode of infection in the first postoperative year.
