This is a tricky problem because the decision making depends on the patients current performance status and whether renal transplantation is imminent.

So if the patient has a satisfactory performance status and renal transplantation is within the next 6-12 months then they may be able to be cleared. This also depends on there not being much in the way of other medical co-morbidities. If not then they may be facing an AVR.

For patients post transplant who develop severe/critical AS then again as long as they a fit enough to undergo the surgery then it should be offered along with all possible measures being undertaken to help preserve renal allograft function peri operatively.

1. Yes. Ideally AVR prior to RT would make their surgical risks very low. But the anti coagulation would make logistic issues in a deceased donor transplant. The ebst would be to offer the transplant and then AVR.

2. From 2nd year post RT, they are "normal" individuals, other than for immunusuppressed status. They would benefit from AVR.

I suggest you take a look at my books, which I wrote with my co-workers and refers to your questions:

Transplantation of Kidney, 2004 Year

Jasenko Karamehic and Associates

P.S. book you have in electronic form on my CV in the bibliography at ResearchGate

I suggest that you look at the other my book, which I wrote with my co-workers and refers to your questions:

Transplantation Kidney and Pancreas, 2013 Year

Clinical and immunological aspects of pharmacotherapy

Jasenko Karamehic and Associates

P.S. book you have in electronic form on my CV in the bibliography at ResearchGate