Molecular and phenotypic characteristics of methicillin-resistant Staphylococcus aureus strains isolated from hospitalized patients in transplantation wards

OBJECTIVES

Hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) frequently causes therapeutic problems and provides information about the epidemiological condition of the ward.

MATERIALS AND METHODS

HA-MRSA isolated from patients on transplantation wards in 1991, 1994, 1996, and from 2005 to 2007 were compared using molecular methods such as restriction fragment length polymorphism-pulse field gel electrophoresis, multilocus sequence typing (MLST), multiplex polymerase chain reaction (PCR) for detection type of staphylococcal chromosomal cassette mec, and PCR for detection.

RESULTS

The analysis covered HA-MRSA strains, each from a different patient. All organisms were typed using molecular methods. MLST results were compared with an international base. The examined strains belonged to five different worldwide known clonal complexes: CC8 (78%), CC5 (12%), CC1 (4%), CC30 (2%), and CC51 (4%). All could be recognized as representatives of a clonal complex CC8 clones: ST239-III (sequence type 239 and SCCmec type III named EMRSA-1, -4, -11, Brasilian, Hungarian) occurred with a frequency of 35.9%, ST254-IV (EMRSA-10, Hannover) occurred in 33.3%, ST247-I (EMRSA-5,-7, Iberian) occurred in 20.5%, ST241-III (Finland-UK) occurred in 5.15%, and ST8-IV (EMRSA-2,-6) occurred in 5.15%.

CONCLUSION

The predomination of different clones of HA-MRSA in the particular years was observed. In 1991, the EMRSA-10 (Hannover) clone predominated (53.3%). The Brasilian-Hungarian (EMRSA-1, -4, -11) clone predominated in 1994 (50%) as well as from 2005 to 2007 (41.3%), whereas in 1996 the Iberian clone was most frequent (53.9%).

Specific character of anaerobic bacterial infections in patients treated in transplantation wards at one of the clinical hospitals in Warsaw

Immunocompromised patients and patients undergoing invasive procedures are predisposed to bacterial infections, due to the possibility of micro-organism translocation from their physiological habitat. Infectious complications may occur both in the early and late post-transplantation periods. The purpose of this study was to evaluate the proportion as well as susceptibility profiles of obligatory anaerobes in the etiology of infections in patients hospitalized at transplantation wards of a large clinical hospital in Warsaw. A total of 104 strains of obligatory anaerobes derived from patients hospitalized in two transplantation clinics at a clinical hospital in Warsaw were evaluated. The strains were isolated from 87 clinical samples collected from 84 patients of two transplantation wards between 2007 and 2012. A total of 104 obligatory anaerobic bacterial strains were isolated and identified, with Gram-positive and Gram-negative bacteria constituting 60.6% and 39.4% of the isolates, respectively. Almost exclusively non-spore-forming anaerobes were detected in evaluated samples. The present study showed all isolated Gram-positive bacteria to be susceptible to ß-lactam antibiotics. Metronidazole-resistant bacteria were found among the genera Propionibacterium and Actinomyces. All Gram-negative rods were susceptible to imipenem and metronidazole. Among them, Bacteroides spp. and Parabacteroides distasonis showed resistance to penicillin G (100%). Because of their pathogenicity and altered antibiotic susceptibility profiles, the bacteria of the genera Bacteroides and Parabacteroides are of greatest clinical importance. Approximately 25% of isolates exhibit also resistance to clindamycin. Because of the growing rates of clindamycin resistance, the role of metronidazole in the treatment of Bacteroides spp. is of increasing importance.

Kidney transplantation does not increase the level of basic hope or life satisfaction compared with hemodialysis in patients with chronic kidney disease

INTRODUCTION

Although renal replacement therapy can lead to improved health, it also can cause emotional disturbances in patients. It is believed that the success of renal replacement therapy hinges not only on medical parameters, but also on psychosocial factors, which is why modern medicine provides an ever-increasing role in the improvement of patients' quality of life.

PURPOSE

The purpose of this study was to compare the level of life satisfaction, purpose in life, and basic hope in patients who had received renal replacement due to chronic kidney disease. We also tested whether the specific type of renal replacement therapy and kidney function parameters were influential factors on the above variables.

PATIENTS AND METHODS

Sixty-one adult patients treated via renal replacement for chronic kidney disease took part in the study. Patients were divided into two groups: 31 hemodialysis patients (15 women and 16 men, ages 23-77 years, mean 51.19 years, SD 14.53 years) and 30 patients who had undergone kidney transplantation (14 women and 16 men, ages 22-69 years, mean 48.40 years, SD 12.64 years). The following research tools were used for analysis: Satisfaction With Life Scale (SWLS), Purpose in Life Test (PIL), and Basic Hope Inventory (BHI-12).

RESULTS

There were no statistical differences in the level of satisfaction with life between hemodialysis patients and postkidney transplant patients. The results for the SWLS obtained from both groups fell within the normal range. The average SWLS for hemodialysis patients remained 20.61, SD = 5.79; for postkidney transplant patients, it was 22.57, SD = 5.16. The PIL level in the group of hemodialysis patients (101.5, SD = 15.64) was significantly lower than in the group of postkidney transplant patients (109.7, SD = 15.54). The average BHI-12 level was similar in both groups. The average BHI-12 result for hemodialysis patients was 29.00 (SD = 5.06), and for postkidney transplant patients 29.93 (SD = 3.55). The correlations between the psychological variables and selected biochemical parameters are worthy of particular attention. Among hemodialysis patients, there was an additional correlation between SWLS and hematocrit; whereas for postkidney transplant patients, there was an additional correlation of PIL and eGFR.

CONCLUSIONS

Our data show that satisfaction with life and basic hope do not increase in patients after renal replacement therapy. The form of renal replacement therapy (hemodialysis or kidney transplantation) does not change the above variables. Patients treated via renal replacement require specialized psychological support to improve the efficacy of renal replacement therapy.

Dramatic recurrence of cancer in a patient who underwent kidney transplantation--case report

BACKGROUND

Besides cardiovascular diseases and infections, cancers are the main cause of death in patients after transplantation of a vascularized organ. After transplantation, usually de novo cancers develop. Recurrences of cancers that had been diagnosed and treated before transplantation are much rarer. In exceptional cases, cancer is transferred with the donor's organ. The epidemiology and the course of post-transplantation de novo neoplasia is relatively well known. However, the issue of recurrence of pre-transplantation cancer, which is significantly rarer and its course more individualized and difficult to predict, poses a challenge to contemporary transplantation.

CASE REPORT

This paper presents an unexpectedly rapid recurrence of rare cancer-endometrial stromal sarcoma-that occurred shortly after transplantation of a kidney from a deceased donor to a patient who had undergone cancer treatment 7 years earlier. The dramatic course of the disease, complicated with recurrent massive thrombosis of the inferior vena cava and the right cardiac cavities, as well as pulmonary embolism and serious infectious complications, illustrates the difficulties related to qualifying patients with a history of malignancy for transplantation.

CONCLUSIONS

Based on this case report, we attempt to find an answer to the question about the risk of cancer recurrence in patients receiving immunosuppressive therapy and find out how it can be minimized. Answering these questions is particularly important if the recurrent cancer is substantially more aggressive, cancer treatment options are limited, and the prognosis is poor due to lack of immunocompetence.

Multivariate analysis of complications after simultaneous pancreas and kidney transplantation

OBJECTIVE

Identification of factors that have an impact on postoperative complications after simultaneous pancreas and kidney transplantation (SPKTx) could help overcome limitations of this kind of treatment.

METHODS

Postoperative complications among 112 SPKTx recipients were divided into 3 groups: related to transplanted pancreas (n = 66), related to transplanted kidney (n = 23) and general surgical complications (n = 31) 120 refers to complications among 112 recipients. According to the modified Clavien-Dindo scale, complications were classified according to their severity for each group. Risk factors for complication development related to donor, recipient, surgical technique, and immunosuppression were included to establish the multivariable model using logistic regression.

RESULTS

Multiple regression analysis showed the following independent factors influenced mortal complications due to transplanted pancreas: age of donor (OR, 1.07; P < .04), duration of vascular pancreas anastomosis above 35 minutes (OR, 3.94; P < .04) and duration of recipient dialysis above 24 months before transplantation (OR, 0.14; P < .01). Area under receiver operating characteristic curve for this model was 0.8.

CONCLUSION

To improve results, the following modification of identified risk factors should be assumed: selection of donor in term of age, shortening of the second warm ischemia time, and adjustment of the waiting list to avoid prolongation of recipient dialysis before SPKTx.

Bacterial and fungal infections in the early post-transplant period after kidney transplantation: etiological agents and their susceptibility

BACKGROUND

Infections remain serious complications in solid-organ transplant recipients, despite professional medical care, the introduction of new immunosuppressive drugs, and treatment that decreases the risk of infections.

METHODS

The study covered 295 adult patients undergoing kidney transplantation (KTx) between September 2001 and December 2007. All the patients were followed prospectively for infections from the KTx date and during the first 4 weeks after surgery. Samples of clinical materials were investigated for microbiological cultures. The microorganisms were cultured and identified in accordance with standard bacteriological procedures. Susceptibility testing was carried out through the use of Clinical and Laboratory Standards Institute procedures.

RESULTS

From 295 KTx recipients, 1073 clinical samples were taken for microbiological examination. Positive cultures were 26.9% (n = 289) of all samples tested; 525 strains were collected. Gram-positive bacteria were isolated in 52.2% (n = 274), Gram-negative bacteria were isolated in 40.8% (n = 214), and fungal strains were isolated in 7% (n = 37). Urine specimens (n = 582) were obtained from 84.5% of 245 recipients during the first month after transplantation. Among the isolated bacterial strains (n = 291), the most common were Gram-negative bacteria (56.4%). Gram-positive bacteria comprised 35.7%; fungal strains were found in 23 cases (7.9%). In surgical site specimens (n = 309), Gram-positive bacteria (72.1%) were the most common. Gram-negative bacteria comprised 24.4%. In blood specimens (n = 138), Gram-positive bacteria (81.6%) were the most common. Gram-negative bacteria comprised 15.8%; fungi were isolated in 2.6%. In respiratory tract specimens (n = 13), among the isolated bacterial strains (n = 8), the most common were Gram-positive bacteria (57.1%). Gram-negative bacteria comprised 14.3%; fungi were isolated in 28.6%.

CONCLUSIONS

Urine samples were predominantly positive after KTx. Our study showed Gram-positive bacteria in 52.2% after kidney transplantation. The proportion of isolates of multi-drug-resistant bacterial strains (MRCNS, vancomycin-resistant strains, high-level aminoglycoside-resistant strains, extended-spectrum beta-lactamase producers, and high-level aminoglycoside-resistant strains) was increased. These data indicate the need for strict adherence to infection control procedures in these patients.

Impact of pretransplant body mass index on early kidney graft function

BACKGROUND

An increase in the number of obese patients on transplantation waiting lists can be observed. There are conflicting results regarding the influence of body mass index (BMI) on graft function.

METHODS

We performed a single-center, retrospective study of 859 adult patients who received a renal graft from deceased donors. BMI (kg/m(2)) was calculated from patients' height and weight at the time of transplantation. Kidney recipients were subgrouped into 4 groups, according to their BMI: Groups A (<18.5; n = 57), B (18.6-24.9; n = 565), C (25-29.9; n = 198) and D (>30; n = 39). Primary or delayed graft function (DGF), acute rejection (AR) episodes, and number of reoperations, graft function expressed by glomerular filtration rate (GFR) and serum creatinine concentration and number of graft loss as well as the recipient's death were analyzed. The follow-up period was 1 year.

RESULTS

Obese patients' grafts do not develop any function more frequently in comparison with their nonobese counterparts (P < .0001; odds ratio [OR], 32.364; 95% CI, 2.174-941.422). Other aspects of the procedure were analyzed to confirm that thesis: Cold ischemia time and number of HLA mismatches affect the frequency of AR (OR, 1.0182 [P = .0029] and OR, 1.1496 [P = .0147], respectively); moreover, donor median creatinine serum concentration (P = .00004) and cold ischemia time (P = .00019) are related to delayed graft function. BMI did not influence the incidence of DGF (P = .08, OR; 1.167; 95% CI, 0.562-2.409), the number of AR episodes (P > .1; OR, 1.745; 95% CI, 0.846-3.575), number of reoperations, GFR (P = .22-.92), or creatinine concentration (P = .09). Number of graft losses (P = .12; OR, 1.8; 95% CI, 0.770-4.184) or patient deaths (P = .216; OR, 3.69; 95% CI, 0.153-36.444) were not influenced.

CONCLUSION

Greater recipient BMI at the time of transplantation has a significant influence on the incidence of primary graft failure.

Rapid normalization of severe hypercholesterolemia mediated by lipoprotein X after liver transplantation in a patient with cholestasis - a case report

Hypercholesterolemia is a common disorder in adult population, but total cholesterol concentrations beyond 1000 mg/dl occur rarely, and are found in patients with homozygous familial hypercholesterolemia and familial lecithin-cholesterol acyltransferase deficiency, in chronic graft-versus-host disease of the liver, after intravenous infusion of fat emulsion (intralipid), in newborn infants with immature liver function, and in obstructive biliary cholestasis. Cholestasis induces a dramatic increase in plasma cholesterol and the appearance of an abnormal lipoprotein, lipoprotein X (LpX), in the plasma. We report a case of severe hypercholesterolemia mediated by LpX in a patient transplanted for primary biliary cirrhosis (PBC), who was qualified for liver re-transplantation (re-LTx) due to chronic cholestasis. Four months after re-LTx, the cholesterol concentration was normal. The problems in diagnosis and treatment are discussed.

Biomarkers of delayed graft function as a form of acute kidney injury in kidney transplantation

Renal transplantation ensures distinct advantages for patients with end-stage kidney disease. However, in some cases early complications can lead to allograft dysfunction and consequently graft loss. One of the most common early complications after kidney transplantation is delayed graft function (DGF). Unfortunately there is no effective treatment for DGF, however early diagnosis of DGF and therapeutic intervention (eg modification of immunosuppression) may improve outcome. Therefore, markers of acute kidney injury are required. Creatinine is a poor biomarker for kidney injury due principally to its inability to help diagnose early acute renal failure and complete inability to help differentiate among its various causes. Different urinary and serum proteins have been intensively investigated as possible biomarkers in this setting. There are promising candidate biomarkers with the ability to detect DGF. We focused on emerging biomarkers of DGF with NGAL is being the most studied followed by KIM-1, L-FABP, IL-18, and others. However, large randomized studies are needed to establish the value of new, promising biomarkers, in DGF diagnosis, prognosis and its cost-effectiveness.

The first Polish liver transplantation after Roux-en-Y gastric bypass surgery for morbid obesity: a case report and literature review

BACKGROUND

Morbid obesity is associated with liver pathology, most commonly non-alcoholic steatohepatitis (NASH) leading to cirrhosis. However, the morbid obesity impedes qualification for organ transplantation.

CASE REPORT

We present a case report of a 56-year-old woman who underwent bariatric procedure followed by liver transplantation (LTx). Her initial weight was 130.2 kg (BMI 50.9 kg/m2). The patient had a history of arterial hypertension, diabetes, gonarthrosis, and obstructive sleep apnea syndrome and no history of alcohol abuse. She underwent Roux-en-Y gastric bypass (RYGB) procedure. The routine intraoperative liver biopsy revealed fibrosis (III°), steatosis (II°), and intra-acinar inflammation. The operation led to a substantial loss of weight. Two years after the surgery the patient was referred to the Transplantation Clinic of Department of General Surgery and Transplantology with suspicion of liver failure due to advanced cirrhosis, which could be a result of previously diagnosed NASH and, probably, excessive alcohol use after bariatric surgery. The patient was qualified for elective LTx, which was performed 3 years after the RYGB. Immediately before LTx, the patient's weight was 65 kg (BMI 25.4 kg/m²). The postoperative period was complicated by bleeding into the peritoneal cavity, which required reoperation. She also had renal failure, requiring renal replacement therapy. One year after LTx, she showed stable liver function with normal transaminases activity and bilirubin concentration, remission of diabetes, and good renal function.

CONCLUSIONS

Steatohepatitis in morbidly obese patients may lead to cirrhosis. Bariatric procedure can be a bridge to liver transplantation for morbidly obese patients with advanced liver fibrosis.

Professor Boles aw Rutkowski's 70th birthday Laudatio

On 5 December 2014 Professor Bolesław Rutkowski, the outstanding Polish nephrologist, doctor and researcher, renowned organizer, our teacher, colleague and friend, will celebrate his 70th birthday. We would like to take this opportunity to present to you his life and his scientific achievements.

Improvement of graft function following Roux-en-Y gastric bypass surgery in a morbidly obese kidney recipient: a case report and literature review

BACKGROUND

Transplantation is the best and approved method of renal replacement therapy. Graft function depends not only on proper regulation of immune processes but also on the optimal control of chronic diseases. The obesity epidemic involves the healthy population and organ recipients equally. Obesity and metabolic syndrome lead to a number of disorders exerting adverse effects on the transplanted organ.

CASE REPORT

We report a case of a kidney recipient, 12 years after transplantation, with chronic graft failure (serum creatinine level 2.1 mg/dl, GFR 31 ml/min/1.73 m(2)), morbid obesity (weight 139.8 kg, BMI 46.2 kg/m(2), excess body mass 73.1 kg), hypertension, poorly controlled type 1 diabetes (HbA1c 8.8%), and ischemic heart disease. The cause of chronic kidney disease was diabetic nephropathy. The patient was the first Polish kidney recipient referred for bariatric gastric bypass surgery (GB). Directly after surgery, transient creatinine elevation (4.7 mg/dl) was noted. There was no reduction in diuresis. Desired weight loss was achieved within 12 months after surgery (body mass 81.9, BMI 27.1 kg/m(2), percentage loss of excess weight 86.9%) with improved graft function (serum creatinine level 1.3 mg/dl, GFR 45.1 ml/min/1.73 m(2)) and reduction of daily insulin requirement from 74 to 40 units. The severity of hypertension and ischemic heart disease diminished as well.

CONCLUSIONS

Metabolic surgery is the best treatment of obesity and may contribute to post-transplantation care if weight gain is observed, as a result of the interaction of many factors leading to deterioration of renal graft function.

Profiles of all 550 procurements and transplantations of kidneys from living donors in Poland, 1967-2012

INTRODUCTION

Nationwide live organ donor registry is mandatory to ensure the quality and safety of kidney procurement from living donors and for donor protection. In Poland, this concept is achieved with the use of an Internet tool (www.rejestry.net); donation centers are obligated to collect donors' data (demographic characteristics, including pre-, peri-, and post-donation and long-term follow-up). The registry currently handles data from 2008 but is incomplete in the collection of historical procurements. The goal of the research was to collect in one database all information regarding cases of kidney procurements and transplantations from living donors in Poland starting from the first such transplant in 1967.

MATERIALS AND METHODS

Data were gathered from several existing but incomplete records stored by transplant centers.

RESULTS

A total of 550 kidney procurements and transplantations from living donors were made in the years 1967 to 2012. We collected 100% of information on the date and donation centers and 100% of information regarding the recipients but only 65% of information regarding the donor and 80% regarding donor-recipient relations. According to the data, women accounted for 60% of living donors and men for 40% of living donors. The mean age of a donor was 45 years, and the mean age of a recipient was 28 years. Among related donors, parents constituted the majority (59%), siblings accounted for 21%, and spouses accounted for 12%.

CONCLUSIONS

Although the collected data are incomplete, our research provided the Polish live-donor registry a solid starting point (eg, all dates, center procurements, records of transplantations) to enter remaining data and to build a serviceable tool for full assessment of all live-donor kidney donations in the country.

When less is more--case report of successful renal transplantation from a living unrelated donor to a high-risk female recipient

Qualification for kidney transplantation for patients with a long history of renal replacement therapy and numerous medical complications requires individual analysis of all contraindications and limitations as well as advantages of the procedure. In this case report, we analyze the qualification process and posttransplantation course of a 28-year-old female patient with end-stage renal failure due to reflux nephropathy, treated with renal replacement therapy since early childhood, who received her second kidney transplant with glomerular filtration rate <40 mL/min/1.73 m(2) from a living, unrelated donor in 2009. Despite the high risk of immunological and surgical complications, transplanting organs of borderline excretory capacity, and no human leukocyte antigen matching, significant health benefits were achieved. Procurement of a kidney with borderline filtering function reduces the risk of potential negative consequences of impaired remnant filtration in the living donor. Following the principle of procuring a kidney with worse parameters from the living donors, it is necessary to perform an examination evaluating the function of each kidney. Procurement of a kidney with significantly worse parameters requires an individual assessment of benefits for the recipient.

Evaluation of the prevalence of insertion element IS16 in vancomycin-resistant enterococci strains of Enterococcus faecium isolated from transplantology patients from a Warsaw Hospital between 2010 and 2012

The study included 79 vancomycin-resistant Enterococcus faecium (VRE) strains isolated from 33 patients after kidney (n = 19) or liver (n = 14) transplantation; these patients were hospitalized between 2010 and 2012. The strains were obtained from infected persons as well as from carriers. All examined strains were tested for the susceptibility to antimicrobials active against enterococci and for the presence of vanA and vanB genes as well as the presence of the insertion sequence IS16 considered as one of the markers of hospital-associated strains. All 79 VRE strains of E faecium possessed IS16 and the vanA (vanB-negative) determinant. All tested strains were resistant to at least three groups of drugs; therefore, they were recognized as multidrug resistant. All isolates were resistant to glycopeptides, ampicillin, and most were resistant to tetracyclines, macrolides, nitrofurans, and high concentrations of aminoglycosides. The presence of insertion element IS16 and multiple resistance determinants prove that strains colonizing or infecting solid organ recipients were typical nosocomial pathogens.

Bacterial and fungal infections in the early post-transplantation period after simultaneous pancreas-kidney transplantation: etiological agents and their susceptibility

OBJECTIVE

This study aims to evaluate the frequency of microbial isolates and their susceptibility profiles cultured from clinical samples obtained from 26 simultaneous pancreas-kidney transplant (SPK) recipients suspected of infections during the early post-transplantation period.

PATIENTS AND METHODS

Data on microbiologic culture of 26 adult patients undergoing SPK were collected prospectively from 2001 to the end of 2006. Isolation and identification of cultured micro-organisms were performed according to standard microbiological procedures and commercially available tests. Susceptibility of the strains to antibacterial agents was made by the Clinical and Laboratory Standards Institute guidelines.

RESULTS

All the patients were followed prospectively for the first 4 weeks after surgery. In total, 263 samples from clinical materials obtained from 26 SPK recipients were cultured. Bacterial cultures were positive in 29.3% (n = 77) clinical samples. Of these, 219 microbial strains were cultured. Gram-positive bacteria were found in 64% (n = 140), Gram-negative bacteria in 22.8% (n = 50), and fungal strains were isolated in 13.2% (n = 29). Incidence rate values for subsequent isolation of micro-organisms in the sub-periods of time for decreasing the SPK were Gram-positive bacteria (102.3-18.7; I versus IV), growing the Gram-negative bacteria (14-46.1 I versus III) IV were 14, decreasing to fungi (22.1-1.6, I versus IV). Until now this early post-transplantation period was considered homogeneous time after transplantation. This study shows that this period is actually heterogenous, with statistically significant differences being observed between results obtained in consecutive 4 weeks after transplantation.

CONCLUSIONS

The results of this study show that the incidence rate was elevated with increasing age in the SPK group of patients. In the SPK group, our data showed the highest rate of isolation of micro-organisms compared with recipients of kidneys or liver.

Cardiovascular disease and kidney transplantation‑evaluation of potential transplant recipient

Cardiovascular evaluation of a potential kidney transplant recipient remains controversial. The burning issue is the lack of clear guidelines as well as the fact that patients with a low probability of cardiovascular disease undergo numerous unnecessary screening procedures and false‑positive results are common. In general, the standard procedure involves clinical data collection, physical examination, electrocardiography, chest‑X ray, measurement of the lipid profile and fasting glycemia, cardiac ultrasonography, followed by coronary angiography. An exercise tolerance test is not recommended because it has low sensitivity and is difficult to perform and interpret. Cardiac ultrasonography should be performed after a hemodialysis session to avoid an effect on hypervolemia. All noninvasive diagnostic imaging and isotope tests are usually of limited value and, to a large extent, are facility- and operator‑dependent. Coronary angiography should be considered in patients with positive exercise tolerance test results and a history of acute coronary syndrome, unstable coronary artery disease, and high cardiovascular risk. However, a decision regarding therapy, ie, percutaneous coronary intervention, stenting (type of stent), or coronary artery bypass grafting should be made during the meeting of a cardiac team. The guidelines also discuss cardiac contraindications to kidney transplantation. It should be stressed that a patient scheduled for a kidney transplant is sick at the time of evaluation and that his or her condition may change after several years on the waiting list. Therefore, cardiac reevaluation may be needed. Preemptive transplantation as well as short dialysis therapy before transplantation (<6 months) are associated with better patient and graft survival and thus with lower incidence of cardiovascular complications and better quality of life. The current review discusses the available guidelines on the evaluation of the potential kidney transplant recipient.