From the Research
The absolute contraindication to renal transplantation among the given options is not explicitly listed, but based on the provided evidence, active malignancy or recent history of cancer, such as lung cancer, represents a significant concern due to the risk of recurrence when immunosuppressive medications are initiated post-transplant. According to the study by 1, immunosuppressive treatments used in renal transplant recipients can cause malignancy by supporting oncogenesis caused by certain viruses or by impairing immune surveillance, thereby enabling faster tumor growth.
Analysis of Options
- Chronic osteomyelitis (option A) requires treatment before transplantation but is not an absolute contraindication, as indicated by the general principles of managing infections before transplant.
- Diabetes mellitus (option B) is actually a common cause of end-stage renal disease requiring transplantation, and its management is crucial in the transplant population, as discussed in 2.
- Exertional angina (option D) requires cardiac evaluation and possible intervention but doesn't absolutely preclude transplantation, as cardiac issues can often be managed to allow for transplantation.
- Age over 55 (option E) is not a contraindication, as many successful transplants are performed in older adults with appropriate evaluation of physiologic rather than chronological age.
Consideration of Evidence
The study by 3 highlights diseases with high risk of aggressive relapse in the grafts as absolute contraindications for living donation, including focal and segmental hyalinosis, atypical hemolytic uremic syndrome, and primary hyperoxaluria. However, these are not listed among the options provided. The most relevant consideration from the provided options relates to the risk of malignancy recurrence, as discussed in 1 and 4, which suggests that a history of cancer, particularly one with a high risk of late recurrence like lung cancer, would be a significant concern for transplantation due to the immunosuppressive regimen required post-transplant.
Recommendation
Given the options and the emphasis on malignancy as a significant risk factor for post-transplant complications, the closest answer to an absolute contraindication based on the provided choices would be related to malignancy. However, it's crucial to note that the specific options provided do not directly align with the absolute contraindications outlined in the evidence, which focus more on specific diseases with high recurrence risks in the graft. Therefore, the decision should be highly individualized, considering the latest evidence and the specific clinical context of the patient.