This case involves a 56-year-old male with Ankylosing Spondylitis, developing Chronic Kidney Disease due to chronic NSAID use. Comorbidities include hypertension, gouty arthritis, and nephrolithiasis. Despite being on hemodialysis, he pursued a kidney transplant. Complications during transplant evaluation led to the deferral of the procedure and discontinuation of immunosuppression. Subsequent challenges included septic shock, anaphylactic reactions, severe anemia, and thrombocytopenia, requiring multiple interventions. Postponed transplantation, COVID-19, and a catheter-related bloodstream infection further complicated the patient’s journey. Despite setbacks, he resumed the transplant workup, highlighting the intricate management required in navigating complex medical conditions.

Learning objectives:

1. To discuss a case of kidney transplant candidate who has several co-morbidities.
2. To discuss the approach to the work-up of a kidney transplant patient.
3. To evaluate the specific transplantation risk factor related to organ system disease of a transplant candidate.

Further reading:

1. Danovitch, Gabriel M., Handbook of Kidney Transplantation. 6th edition, 2017.
2. 2022 American College of Rheumatology/ American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients with Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty.
3. Timing of Elective Surgery and Risk Assessment after SARS-CoV-2 Infection:2023 Update
4. Kidney Transplantation in Adults: HLA-incompatible Transplantation Interpreting Anti-HLA Antibody Testing Data: A Practical Guide for Physicians.