Challenging frontiers in renal transplantation

The aim of this thesis is to address numerous challenges that the practice of renal transplantation is currently facing. This thesis is the product of a fruitful collaboration between nephrologists, transplant surgeons, pathologists, transplant coordinators, biologists, nurses, and policy makers. Most chapters are based on healthcare data from the Dutch Organ Transplant Registry (NOTR) maintained by the Dutch Transplant Foundation, incorporating also data from the Dutch Renal Replacement Registry (RENINE) hosted by Nefrovisie. With these data, we aim to guide decision making in a variety of often difficult topics in renal transplantation, e.g., should an elderly patient >75 years of age still opt for kidney transplantation after waiting several years? The thesis outline the outcomes of transplantation in the elderly, and the comparison with dialysis. With complex epidemiological analyses, this thesis provide answers to these questions with tools to help the clinician and his or her patient to reach an informed decision for a personalized and optimal course of treatment for ESRD. Also, this thesis demonstrates several ways to optimize the donor potential for kidney transplantation. We also discussed utility of the KDRI (kidney donor risk index) risk score in the Netherlands, and how it could benefit allocation strategy. Finally, we introduced a new method to tailor screening visits and reduce the burden for transplant patients.