Absolute Contraindications to Renal Transplantation
Active malignancy, including lung cancer treated less than 5 years ago, is an absolute contraindication to renal transplantation due to the high risk of recurrence and mortality. 1
Among the options presented in the question, the correct answer is (d) lung cancer treated 10 years ago, as this is not an absolute contraindication to renal transplantation.
Analysis of Each Option
(a) Chronic osteomyelitis
Chronic osteomyelitis is considered a relative contraindication, not an absolute one. According to current guidelines, controlled chronic infections such as chronic osteomyelitis can be managed with appropriate antimicrobial therapy 1. Therefore, this is not an absolute contraindication.
(b) Diabetes mellitus
Diabetes mellitus is not listed as an absolute contraindication to renal transplantation in any of the guidelines. In fact, diabetic nephropathy is one of the common indications for renal transplantation. While diabetes may complicate post-transplant management, it is not an absolute contraindication.
(c) Age >55 years
Advanced age (>55 years) is not an absolute contraindication to renal transplantation. Modern transplant guidelines specifically note that advanced age alone should not exclude patients from transplantation consideration 1. Transplant eligibility should be based on physiological status rather than chronological age.
(d) Lung cancer treated 10 years ago
Lung cancer generally requires a disease-free interval of at least 5 years before transplantation can be considered 1. Since this option mentions treatment 10 years ago (well beyond the required waiting period), it is not an absolute contraindication.
(e) Exertional angina
Cardiovascular disease, including exertional angina, requires careful evaluation but is not an absolute contraindication. Guidelines indicate that patients with stable and manageable cardiovascular conditions can be considered for transplantation 1.
True Absolute Contraindications to Renal Transplantation
According to the most recent guidelines, the absolute contraindications to renal transplantation include:
- Active malignancy (not in remission)
- Advanced AIDS
- Severe cardiorespiratory disease
- Uncontrolled infection 1
For patients with established cirrhosis and portal hypertension who fail HCV antiviral treatment, isolated renal transplantation may be contraindicated, and combined liver-kidney transplantation should be considered 2.
Important Clinical Considerations
When evaluating potential renal transplant candidates:
- Screen thoroughly for absolute contraindications
- Assess relative contraindications in the context of the patient's overall health
- Consider the risk-benefit ratio, including mortality risk on dialysis versus post-transplant
- Evaluate the potential for quality of life improvement
- Assess the patient's ability to adhere to complex post-transplant medication regimens 1
For patients with previous malignancy, cancer-specific waiting periods must be observed, with most solid tumors requiring a 2-5 year disease-free interval. Lung cancer specifically requires a longer waiting period (5+ years) due to its higher recurrence risk 1.