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A medical evaluation of prospective renal transplant recipients is performed to identify conditions that may exclude patients from transplantation because of unacceptable risks. Protocols for evaluating potential transplant candidates are available, but there is little information about reasons for excluding patients from transplantation. To assess the effectiveness and cost of our renal transplant-recipient evaluation process, we retrospectively reviewed patients excluded from renal transplantation between January 1993 and December 1995 to categorize the reasons for exclusion. We also examined the costs of the evaluation. The study group included all adults referred for kidney- only transplantation during the study period who were excluded from transplantation (n=125). Demographics of the 160 patients with end- stage renal disease (ESRD) who underwent renal transplantation during the study period were also examined. Compared with the patients who underwent transplantation, the excluded patients were older (48+/-14 v 43+/-12 years; P=0.006) and more likely to be women (66 of 125 patients; 53% v 57 of 160 patients; 36%; P=0.005) and diabetic (59 of 125 patients; 47% v 30 of 160 patients; 19%; P=0.005). The most common reason for excluding patients was medical contraindication (46%), followed by patient declined (25%), obesity (10%, defined as a body mass index [BMI] > or = 35), patient death (6%), and insurance/financial (5%). The medical reasons for exclusion were heart disease (38%), noncompliance (28%), miscellaneous (22%), and cancer (12%). Tests performed after the initial evaluation included cardiac testing (stress thallium or echocardiography and coronary angiography) in 50 patients, Doppler studies of the lower extremities in 28 patients, and hepatitis C polymerase chain reaction (PCR) or recombinant immunoblot assay (RIBA) assays in 8 patients. The cost of standard pretransplantation blood work for selected tests (ABO blood group typing, HLA, hepatitis B and C, and cytomegalovirus) was $709. Deferring such routine pretransplantation blood work until after the patient education session and history and physical examinations by nephrology and surgery in the 31 patients (25%) who declined transplantation at the initial visit would have resulted in considerable savings. Our evaluation process now includes prereferral information on a prospective recipient's medical problems, height and weight, and basic screening laboratory tests. This protocol has resulted in a more efficient and cost-effective evaluation process. Further examination of the cost-effectiveness of the transplant evaluation process is warranted. (Am J Kidney Dis 1998 Oct;32(4):567-74)

Of the 500 adult PRT patients (men:298, women:202; M:W = 1.47; 374 were on Cyclosporine-A [CsA], 77 on Tacrolimus [Tacro] and 49 on Azathioprine-Prednisone [Aza-P]), 44 developed ERY (Hematocrit [Hct] of =50%). Of these 36 were men (82%) and 8 were women (18%), with a M:W = 4.5. PRT ERY developed within 5 months to 10 years after transplantation: 34 (9.0%) were on CsA, 9 (11.7%) on Tacro and 1 (2%) on Aza-P. Red blood cell mass (RBCM) and Plasma Volume (PV) were measured radioisotopically, erythropoietin (EPO) by ELISA. All had expanded RBCM (measured: 2786±99 ml [SEM], expected: 2124±66 ml; p<0.0001) and PV (measured: 3295±109 ml, expected: 3015±70 ml; p<0.002). Oral Enalopril 2.5-10.0 mg daily for several weeks dropped Hct from 53.4±0.5% to 46.7±1.5%, p<0.0004; RBCM to 2211±120 ml, p<0.001, but PV was unchanged (3130±259, p 0.37). Demographics of patients with PRT ERY were no different from those without ERY.PRT ERY was observed in 9% of patients, mostly men. ACEi reduced Hct by 13%, RBCM by 20%, but had no effect on PV. Changes in EPO did not correlate with Hct or RBCM. ACEi is effective in correcting PRT ERY.