Cadaveric Kidney Research Articles

Analysis of kidney transplantation results in patients with chronic renal disease

Introduction. The number of patients with chronic kidney disease has been steadily increasing throughout the world, which makes this pathology a pressing problem. The purpose. The analysis of heterotopic kidney transplantation results. Material and methods. The authors analyzed the experience of the clinical work arrangement, the results of operations, assessed the complication rate and the quality of life in 133 patients after heterotopic cadaveric kidney transplantation performed in the Grodno regional clinical hospital in the period from 2013 to mid August of 2018. Results. In the early postoperative period, complications occurred in 22 (13.5 %) patients, the postoperative mortality was 1.8% (3 patients). In the late postoperative period, the kidney explantation was performed in 4 (2.45%) patients, 6 patients died (3.7%) as a result of progressing comorbidities and complications (average at 15.6±9.8 months after transplantation). A 5-year predicted patient survival after heterotopic kidney transplantation calculated by using the Kaplan-Meier' method was 94.5%. Conclusions. Kidney transplantation in the Grodno Region, the results of operations, graft survival, quality of life and patient survival are comparable to international standards. A careful selection, examination, and preparation of patients for transplantation have a great effect on treatment outcomes.

Cadaveric incidence of renal artery variations at SRTR Govt. Medical College Ambajogai

Introduction: Vascular anomalies related to the renal arteries are not uncommon. The literature indicates that multiple renal arteries are found in 9-76% of cadavers. Two groups of renal artery variations are considered, the early division (ED) and extra renal arteries (ERA). Surgeons operating on the kidney must be acquainted with normal and abnormal anatomy of the renal vessels to avoid inadvertent injury. Aim of this study was to establish the prevalence of cadaveric renal artery variations with the Objective to bring awareness to the surgeons and radiologists performing vascular surgeries and invasive procedures respectively. Materials and Methods: This is a descriptive observational study wherein dissected cadavers were observed for the presence of renal arterial variations. The study was conducted in the department of anatomy, SRTRGMC, Ambajogai, Maharashtra over a period of 2012-2017 and total of 30 cadavers that is total 60 kidneys were observed for the presence of various renal arterial variations during routine abdominal dissection conducted for medical undergraduates. Result: In this present study the incidence of various renal artery variations taken together amongst all cadaveric kidneys observed was 36.66%. Incidence of ERA was 20% and Incidence of ED was 16.66%. Keywords: Renal artery variations, Extra renal artery, Early division, Ladder pattern, Fork pattern.

You Are Just Now Telling Us About This? African American Perspectives of Testing for Genetic Susceptibility to Kidney Disease.

Variants of the APOL1 gene, which encodes apo L1, confer increased risk for CKD, ESKD, and reduced cadaveric kidney transplant survival, and likely contribute to kidney disease disparities among African American individuals in the United States. To date, few studies have gathered African Americans

Clinical practice guidelines for the provision of renal service in Hong Kong: Potential Kidney Transplant Recipient Wait-listing and Evaluation, Deceased Kidney Donor Evaluation, and Kidney Transplant Postoperative Care.

Clinical practice guidelines for the provision of renal service in Hong Kong: Potential Kidney Transplant Recipient Wait-listing and Evaluation, Deceased Kidney Donor Evaluation, and Kidney Transplant Postoperative Care.

Impact of distance between donor and recipient hospitals on cadaveric kidney transplantation outcomes.

The impact of distance between donor and recipient hospitals on outcomes in cadaveric kidney transplantations is unknown. We investigated the association between inter-hospital distance and outcomes in cadaveric kidney transplantations in Japan. We retrospectively analyzed 363 cadaveric kidney transplantations between 2002 and 2017 in Japan. Inter-hospital distance, graft transport time, total ischemic time (TIT), and graft survival were compared between our hospital and national transplantation cohort in Japan. Estimated glomerular filtration rate (eGFR) 1month and 1year after transplantation was compared between cadaveric and living-donor kidney transplantations in our hospitals. Additionally, inter-hospital distances among the seven geographical regions in Japan were assessed. There were 12 and 351 cadaveric kidney transplantations at our hospital and in Japan, respectively. Mean inter-hospital distance at our hospital (217 ± 121km) was significantly longer than that of the national cohort (53 ± 80km; P < 0.001). Mean TIT and graft survival for our hospital and national cohort were 539 ± 200min and 91% and 491 ± 193min and 81%, respectively. Mean eGFRs 1 year after cadaveric and living-donor transplantations at our hospitals were comparable (47 ± 16 vs. 47 ± 15mL/min/1.73m2). The comparison among seven regions in Japan indicated a regional difference in inter-hospital distance with an association between area (km2) and inter-hospital distance (km). Despite the longer inter-hospital distance at our hospital, TIT and transplant outcomes were acceptable in our cases. In addition, geographical inequity in graft allocation in Japan was suggested.

Incidence, Risk Factors, and Outcomes of Delayed Graft Function in Deceased Donor Kidney Transplantation

ObjectiveDelayed graft function (DGF) is the most significant complication of a cadaveric kidney transplant. We aim to evaluate the predictable risk factors of DGF and its effects on the recipient and graft survival. MethodFrom January 2014 to December 2017, the medical records from 62 patients who received a kidney transplant from a deceased donor were retrospectively reviewed. We classified recipients into 2 groups. The risk factors of DGF associated with donor, recipient, and transplant procedures were analyzed. DGF's effects on the graft survival were examined. ResultsThe incidence rate of DGF was 43.5%. Older ages of donors, marginal donors (n = 15), length of stay in the intensive care unit, and terminal serum creatinine concentrations were observed to be statistically significant compared to recipients without DGF (P < .5). The ratio of serum creatinine concentrations before/after brain death was found to be significant for the groups with DGF (P < .05). Cold ischemia time (CIT) was examined as the most significant risk factor on DGF (P = .001). One-year patient survival rates were 94.5% and 92.3%, and graft survival rates were 92.1% and 87.5% (P = .05), respectively, for the groups with and without DGF. ConclusionOlder ages of donors, occurrence of acute kidney injury, its grade just before harvesting, and long duration of CIT are the most important risk factors for DGF. Brain death management, shortening the time between brain death and harvesting, and also shortening the duration of CIT can decrease the risk of DGF and can increase the graft survival.

Epidemiological and Immunological Characteristics of HIV-Infected Patients on the Cadaveric Kidney Donor Waiting List at the Johannesburg Renal Transplant Program.

HIV infection was previously considered an exclusion criterion for renal dialysis and transplant. Recent research has prompted policy changes, allowing for transplantation in this subgroup of patients. Theoretical risks with transplantation include the immune dysregulation associated with post-transplantation immunosuppression and immune activation with possible organ rejection. Assessments for eligibility to renal transplantation rely on a point system, which allocates points based on a patient's age, previous transplants, and time on the waiting list as well as panel reactive antibodies among other parameters. This study aimed at quantifying and defining the clinically relevant characteristics of HIV-infected patients on the cadaveric donor waiting list on the Johannesburg renal transplant program. Clinical records for patients on the transplant list from November 2016 to October 2017 were accessed from existing databases and clinical records. A total of 248 patients were analyzed during the study period. There were a total of 215 HIV-uninfected patients, and 33 HIV-infected patients were on the waiting list. The median age for patients at listing was 39 years (interquartile range 29-47). There were no significant differences in the median age of listing between the HIV-infected and HIV-uninfected groups (p = .7). Hypertension was the most common cause of renal failure in both study groups. The study did not show any significant differences in age or immunological characteristics between the HIV-infected and HIV-uninfected groups. This suggests that for immunological risk stratification purposes, these two groups of patients could be considered equivalent. A possible explanation for this could be that antiretroviral therapy has a significant role in mitigating the effect of the virus on the immune system. Further studies looking at a larger study population are required to corroborate these findings. These data do provide reassurance that HIV-infected patients are suitable candidates for transplantation.

Review of the waiting list for cadaveric kidney transplant Recipients: A Single institution study

Aim: The gold standard treatment of end-stage renal failure is kidney transplantation. In western countries, more than 80% of kidney transplants are cadaveric transplants, in Turkey, this ratio is below 25% due to insufficient cadaveric organ supply. In this study, we aimed to give a general assessment of cadaveric kidney transplant of patients on the waiting list of Istanbul University Medical Faculty General Surgery Organ Transplantation Unit.Material and Methods: Patients waiting for transplantation for a cadaveric kidney on National Organ Waiting List have been evaluated for demographic data, mean duration of dialysis, concomitant diseases, dialysis type, blood groups, end-stage renal failure etiologies, additional diseases that developed during kidney transplant waiting period, and their final status.Results: Two hundred and forty-four patients were included in the study. There were 122 female and 122 male. The median age was 52 (2-77) years. The most common etiology of renal failure was hypertensive nephrosclerosis. The median waiting time was 89 months (13-390). Though there was no difference between female and male patients according to median age, height and BMI, there was a significant difference according to waiting duration (F/M 113/75 months, p 0,017). In the last 1 year, 13 patients died while they were waiting for a kidney transplant and 17 patients lost their chance of kidney transplant due to developing diseases.Conclusion: To increase Turkey’s organ transplantation and cadaveric transplant donation on the waiting list we need to develop donation policy for a shorter period of dialysis and to ensure that patients receive transplantation earlier.Keywords: Dialysis period; kidney transplantation; cadaveric waiting list.

Deceased donor transplantation – Our experience in the last 4 years

Background: Kidney transplant is the best treatment option for end stage kidney disease. Deceased donor transplantation has helped in increasing the donor pool for waitlisted dialysis patients. We received seventy deceased donor kidneys through the Kerala Network of Organ Sharing (KNOS) over the past 4 years from August 2013 to August 2017 and transplanted sixty six with good outcome. Pre-implantation biopsy performed in marginal donors helped in decision making to take the kidney and increase the donor pool. Aims and Objectives: 1)To evaluate outcome of renal transplant recipients in deceased donor transplantation. 2)To evaluate the role of pre-implantation biopsy to improve donor selection for better long term outcome. Materials and Methods: Sixty-six deceased donor kidneys were transplanted into the recipients from our pool of 253 patients registered with the KNOS. Four cadaver kidneys were rejected based on pre-implantation biopsy. Fifty-nine transplants were done at VPS Lakeshore and seven were done at PVS Memorial Hospital, Kochi. Donors of age less than 65 years were considered. Pre-tranpslant evaluation of recipients on waiting list including lab and cardiac evaluation with PRA status was done. Cross match was done prior to transplant. Triple immunosuppression including cyclosporine, mychophenolate mofetil and prednisolone with basiliximab as induction agent was used in all cases. Low dose tacrolimus was introduced after the third month in some cases. Pre-implantation biopsy was done in marginal donors for better donor selection. Results: Of the 66 recipients, 52 (78.8%) were males and 14 (21.2%) were females. PRA status was negative in all recipients. Deceased donors 56% IFTA changes, and other had 30%–40% IFTA changes. Results at 4 years post-transplant showed graft survival in 55/66 (83.34%) and patient survival in 60/66 (90.91%) cases. Six patients died: two with pneumocystis carinii pneumonia (PCP) (at 9 months/3.3 years post-transplant), one with mucormycosis (at 16 months post-transplant), one with acute coronary syndrome (immediate post-transplant), and two patients with sepsis. The average serum creatinine was 2.4 mg/dl in 1 (1.8%) case. The surgical outcome was good in all (100%) patients with no intraoperative surgical complications. Delayed graft function was noted in 18% of patients. Prolonged cold ischemia time was noted in patients with acute tubular necrosis. Six patients had acute rejection, of which two were antibody mediated, and four had acute cellular rejection. One patient had tacrolimus toxicity on biopsy and was shifted to everolimus. Infections included one patient with surgical wound infection, 12 patients with urinary tract infections, one patient with invasive fungal infection, and two patients with PCP. At 4 years, deceased donor transplantation has good graft and patient outcomes. Conclusion: Deceased donor transplantation has good graft outcome which is comparable to live non related donors. It has minimal paper work and less costly than routine live transplant. Pre-implantation biopsy should be considered in marginal donors for appropriate donor selection and avoid organ wastage in doubtful cases. In our study we noted that transplant outcome was better in recipients receiving kidney from with in the city limits because of less cold ischemia time. Hence facilities for early transportation of organs with minimal procedural hurdles to minimize cold ischemia time should be carried out by the concerned authorities. Proactivity from the Government at state, zonal and national level is needed to improve deceased donor pool and cadaver transplantation in India.

Effect of sonication power on perfusion decellularization of cadaveric porcine kidney

Kidney problems rank 7th among the top 10 causes of mortality among Filipinos. One of the potential future treatment options is the use of bioengineered kidney. The preparation of scaffolds is the first step in kidney bioengineering and perfusion decellularization using chemicals is considered the most preferred preparation method to date. However, the use of chemicals alone requires long treatment time hence, in this study perfusion decellularization is to be enhanced by sonication treatment at varying sonication power. Decellularization was carried out by perfusing the kidney with 1% SDS and was subjected to sonication treatment with a 2h sonication and 2h rest cycle. The cycle is repeated until the kidney is clear and transparent. Washing using 1% Triton X-100 and 1x PBS then follows to remove residual SDS. The extent of cell removal was determined by H&amp;E staining. The results showed that decellularization with sonication using 150W, 200W and 250W required a treatment time of 24h, 16h and 12h respectively compared to the 28h treatment time of decellularization without sonication. The result clearly shows that with higher sonication power, the shorter is the decellularization time needed to prepare a good kidney scaffold.

Fatal Curvularia brain abscess in a heart and kidney transplant recipient

A 42-year-old woman with history of heart failure status post orthotopic heart transplant and end stage renal disease presented to the hospital with decompensated heart failure that progressed to cardiogenic shock. She underwent a new orthotopic heart transplant and cadaveric donor kidney transplant. Three weeks later, she experienced right facial droop and right upper extremity weakness. Computed tomography showed a left frontal cortical lesion with vasogenic edema and a central hemorrhagic component. Given the concern for an angioinvasive mold infection, she was started on voriconazole and amphotericin B. Brain biopsy was performed and histopathology revealed septated hyphae with acute angle branching. Mycology culture isolated Curvularia sp. Unfortunately, her mental status deteriorated with subsequent development of multiorgan failure that led to death.

A study of the main determinants of kidney allograft long-term survival in the era of new immunosuppressive drugs.

The outcome of long-term kidney allograft is extremely important. The present study aimed to discern the factors affecting long-term kidney allograft survival, including the type of donation and the use of extended criteria donors. Seven hundred and thirty-seven kidney transplant alone patients entered this retrospective cross-sectional study. The impact of different factors on death-censored long-term kidney allograft survival was evaluated. The Cox proportional survival model was employed to identify these factors. A value of P < 0.05 was considered statistically significant. The data were analyzed using IBM Statistical Package for the Social Sciences version 19.0. The study was conducted at the Mashhad University of Medical Sciences, Mashhad, Iran. In comparison with living kidney donations, both nontraumatic and traumatic brain death cadaveric kidney donations showed statistically significant inferior graft survival. Furthermore, the Kaplan-Meier survival analysis showed better durability of living kidney donations in comparison with traumatic and nontraumatic deceased donors (Log-rank test value = 0.001). Patients with delayed graft function (DGF) had a significantly shorter long-term death censured long-term graft survival in comparison with those without this complication. The Cox proportional models showed that DGF occurrence and the type of donation play a statistically significant role in long-term kidney graft survival. In addition, regarding graft survival, there was no difference between standard criteria and extended criteria donors. The occurrence of DGF and living or deceased types of donations have a significant effect on long-term kidney allograft survival.

A case in which colonic perforation occurred twice 10 years after cadaveric kidney transplantation

A case in which colonic perforation occurred twice 10 years after cadaveric kidney transplantation

Generation of primary cells from ADPKD and normal human kidneys.

Autosomal dominant polycystic kidney (ADPKD) is a common genetic disorder characterized by the presence of numerous fluid-filled cysts that lead to a progressive decline in renal function. Cystic tissues and primary cyst epithelial cells obtained from discarded human ADPKD kidneys provide unique biomaterials for the investigation of cellular mechanisms involved in cyst growth and changes in the microenvironment adjacent to the cysts. ADPKD cells have been used to develop straightforward in vitro cell model assays to study events down-stream of the mutant proteins in carefully controlled experimental conditions, test specific hypotheses, and evaluate the cellular response to potential therapeutic drugs. Normal cadaver kidneys deemed unsuitable for transplantation and "non-involved" portions of nephrectomy specimens removed for the treatment of kidney cancer provide important control tissues and the source of primary normal human kidney (NHK) cells for comparison to ADPKD specimens. This chapter describes the methods used in the collection of cystic and non-cystic tissues from ADPKD and normal kidneys and the generation of primary cell cultures. We also highlight strengths and weaknesses of using immortalized isogenic normal and PKD mutant cell lines.

Revisiting the morphology of pelvicalyceal system in human cadaveric kidneys with a systematic review of literature

ObjectiveRenal collecting system macroscopically consists of minor calyx, major calyx, renal pelvis and ureter. Stone in renal collecting system is a common presentation in everyday urological practice. The prevalence of renal calculi ranges from 4% to 20% in different geographical distribution. Anatomical variation in renal collecting system plays a significant role in formation of calculi in its parts. The large extra renal pelvis leads to stagnation of urine for longer durations and formation of stones. The stone free rate after percutaneous nephrolithotomy and extra corporeal shock wave lithotomy is significantly related to anatomical factors, particularly the type of renal pelvis and dimensions (length and width) of lower infundibulum. Previous authors described the morphology of pelvicalyceal system in a highly variable manner and the available anatomical description of pelvicalyceal system is contradictory and incomplete. Hence an attempt has been made to provide the precise anatomy of pelvicalyceal system in adult human kidneys. MethodsWe studied 196 formalin embalmed kidneys to note the number of infundibulum, major and minor calyces. The location and shape of pelvis were also studied. ResultsThe intra-renal pelvis was narrow and had funnel shaped appearance in 95 of total 196 (48.5%) specimens, and the extra-renal pelvis was dilated as balloon shaped in 43 of 196 (21.9%) specimens. In 41 (20.9%) specimens, the renal pelvis was having partially intra- and extra-renal in location. Bilateral symmetry was found in only 27.1% of 196 renal collecting systems. The length of lower infundibulum was more than 22 mm in 19 (9.7%) of 196 cases which directly affects the stone clearance rate during open and endoscopic surgeries on pelvicalyceal system. ConclusionThis study provides the accurate morphological details of the shape and dimensions of renal pelvicalyceal system to help the urologists and nephrologists.

Инфекционные осложнения в отдаленном посттрансплантационном периоде у реципиентов почечного трансплантата в сочетании с фотофорезом

to evaluate the influence of prophylactic use of photopheresis on the risk of long-term infective complications after kidney transplantation. The open cohort randomized study was conducted. A total of 60 recipients after cadaveric kidney allotransplantation from 30 donors were assessed. The patients were randomized into two groups (n=30). All transplants were paired, and one kidney was transplanted to patient in intervention group and the another one was transplanted to patient in control group. In the intervention group all patients received standard immunosuppression therapy (tacrolimus, mycophenolate, prednisone) and 10-15 sessions of photopheresis during first 6 months after the transplantation. In the control group only the immunosuppression therapy was given. The follow-up period ranged from 2 to 7 years, an average 4.5+/-2.0 years. The rate infective complications in the both groups gradually decreased as the postoperative period increased exponentially, but it was lower in the intervention group than in the control group. The rate of respiratory infection, asymptomatic bacteriuria and viremia, verified by the genetic amplification was 4, 2 and 1.5 times lower in the intervention group. The risk of clinically meaningful infection was significantly lower in the intervention group than in the control group: IRR 0.3888 (95% CI 0.2754; 0.5445; <0.0001). 6-year survival in the intervention group was 100% in comparison to 82.8% in the control group (95% CI 51.6; 93.16). The prophylactic use of the photopheresis allows to decrease the risk of infective complications after the kidney transplantation.

Study of Renal Artery Patterns in a Sri Lankan Population

Introduction The increased frequency of surgical as well as diagnostic and interventional radiological procedures involving the kidneys and the renal vasculature has shown a definite demand for a re-evaluation of the renal arterial anatomy and its variations. Objective The objective of this study was to assess the anatomy of the renal arterial pattern in a Sri Lankan population. Methodology 382 human cadaver kidneys were analyzed for its arterial anatomy. Results Of the 382 kidneys analysed, single renal arteries were found in 260 specimens (68.06%) and 122 (31.94%) had multiple renal arteries. The incidence of multiple renal arteries in males were 30.68% and 34.75%. in females. A higher number of multiple renal arteries were found on the left, ie: 70 out of 122 (57.38%) compared to 52 out of 122 (42.62%) on the right. A superior polar artery was given off from the main renal arteries in 86 kidneys (22.51%) and an inferior polar artery was noted arising from the main renal artery in 29 kidneys (7.59%). Pre-hilar segmental branching was seen in 111 (29.06%) of the main renal arteries. Conclusion 31.9% of our study population had multiple renal arteries. There was no significant difference with regard to the incidence of multiple renal arteries, between the two sexes nor on the sides. Prior knowledge of possible variations that may exist is important for the diagnostic and interventional radiologists, transplant surgeons and urologists. No detailed study has been done in a Sri Lankan population and in this regard our findings may provide some insight to the practising clinician in Sri Lanka.

Enhancing Kidney Supply Through Geographic Sharing in the United States

The deceased‐donor kidney allocation system suffers from a severe shortage of available organs. We illustrate a mechanism which can increase the supply of cadaveric kidneys in the United States. This supply increase exploits the fact that under the current organ allocation policy, some kidneys remain unprocured in some procurement areas but would be highly sought in other areas. The current kidney allocation policy procures within a donor service area (DSA) and offers these kidneys first to patients in the DSA; if these offers are not accepted, the kidney will be offered within the region (a cluster of DSAs); if these offers are not accepted, the kidney will be offered nationally. A deceased‐donor organ is procured if there is the belief that the offered organ will be transplanted (known as “intent”). We conduct an empirical analysis of the donor and recipient data (at the DSA level) which reveals that the intent increases significantly with organ quality, the median waiting time for a transplant, and higher competition. In particular, it shows that lower quality organs are likely to be procured at a higher rate in DSAs with longer waiting times. Motivated by a new kidney allocation system, we conduct a counterfactual study which shows that geographically broader sharing the bottom 15% quality kidneys leads to stronger intent for the organ, thus increasing the supply of procured organs available for transplantation. The expected increase in procured organs ranges from 58 (an increase of 0.4% of all procured kidneys) to 174 (an increase of 1.2%), depending on regional or national sharing.

The Anatomic Structure of a Fused Renal Pyramid and Its Clinical Significance in the Establishment of Percutaneous Renal Access

ObjectiveTo explore the clinical significance of the fused renal pyramid (FRP) in establishing percutaneous renal access, and the anatomic basis for avoiding vascular injury caused by puncturing through this renal pyramid with the aim of achieving accurate puncture in percutaneous nephrolithotomy. Materials and MethodsSixty-two cadaveric kidneys and 105 porcine kidneys were selected for the assessment of regional anatomy, to explore the anatomic structure of the FRP and determine its frequency. Then, we compared the effects of 4 different puncture paths on the occurrence of renal vascular injury when respectively punctured through the normal renal pyramid (group A), the centerline of one side pyramid of the FRP (group B), the center of the entire FRP (group C) and the renal column (group D). ResultsThe incidence of FRP in human kidneys is not low. The artery in the kidney can be divided into 6 grades. The grade IV branch-interlobar artery courses through the FRP. There was significant difference in the degree of arterial injury between the group A and C (P = .003), while no significant difference between the group A and B (P = .151). There was significant difference in the proportion of interlolar artery injury between group A and C (P <.001), while no significant difference between group A and B (P = .239). ConclusionIt is necessary to carefully identify and bypass the FRP when establishing a percutaneous renal access. If unavoidable, the puncture path should be on the centerline of one side pyramid of the FRP.

Colonoscopy as Part of Pre-Transplant Work-Up in Successful Kidney Transplant Candidates: Single-Center Experience and Review of Literature.

BackgroundScreening colonoscopy is not obligatory in kidney pre-transplant work-up guidelines. According to recommendations, only transplant recipients over age 50 years should be screened. The aim of this study was to characterize endoscopic findings revealed as part of pre-transplant work-up.Material/MethodsWe retrospectively reviewed pre-transplant work-up charts of 434 adult patients who received a cadaveric donor kidney transplantation (KT) from 2012 to 2015. Endoscopic findings analysis with age subgroup (<50 and ≥50) analysis were performed.ResultsOut of 434 of patients that underwent KT, 29% have had a colonoscopy. In 75.6% of those, pathologies were found. Hemorrhoids were found in 33% and polyps in 30.7% of patients. Adenoma detection rate (ADR) was 18.1% (67.5% distal predominance). Advanced ADR was 10.2% (distal predominance). Diverticulosis was found in 28.3% of patients and ulcerative colitis was found in 2.4%. In age subgroup analysis, ADR was higher in patients ≥50 years compared to those <50 years (21.6% vs. 4%; p=0.041).ConclusionsColonoscopy as part of pre-transplant work-up enables removal of precancerous lesions and management of benign findings. All candidates meeting criteria for the general population should be screened. Patients under age 50 years could also benefit from colonoscopy as part of the pre-transplant work-up. Therefore, we suggest that baseline colonoscopy should be included in pre-transplant work-up guidelines for all patients, regardless of age. However, further studies are needed to confirm this recommendation.