Review of patients on the renal transplant waiting list

All patients on the active transplant waiting list should be reviewed annually. In straightforward patients this involves case note review and discussion with the referring nephrologist. More complex patients are seen in a transplant review clinic in Plymouth or at their referring unit.

All patients on the transplant waiting list have ECG and CXR annually, any abnormality undergoing appropriate investigation, as per the initial assessment protocol.

Asymptomatic, non-diabetic patients reaching the age of 50, or being diagnosed as diabetic, undergo non-invasive assessment of myocardial perfusion.

High risk asymptomatic patients (over 50, diabetic, abnormal ECG) should undergo repeat cardiac stress testing every 2 years, while awaiting renal transplantation, even if they had a normal coronary angiogram (more than 2 years ago), remain asymptomatic and have no abnormalities on ECG/CXR.

Asymptomatic patients who had abnormal coronary angiography (with or without revascularisation), prior to activation, should have repeat myocardial perfusion scanning annually (preferably off beta blockers), and repeat coronary angiography if there is any significant change in the area of fixed or reversible ischaemia.