Dialysis issues prior to and after renal transplantation
- Vijaya Venkataraman, MD
Vijaya Venkataraman, MD
- Consultant Nephrologist
- Kidney Specialists Inc. Columbus, OH
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Washington University School of Medicine
- Brent W Miller, MD
Brent W Miller, MD
- Professor of Medicine
- Washington University School of Medicine
Patients who receive a kidney transplant (allograft or graft) have markedly decreased mortality compared with patients who are on dialysis. (See "Patient survival after renal transplantation".)
Preemptive transplantation, defined as elective transplantation prior to the requirement for chronic dialysis, allows the patient to avoid dialysis completely. Preemptive transplantation improves patient survival compared with transplantation after initiation of dialysis. However, dialysis is often required by patients who are awaiting transplantation or who receive a transplant that does not work immediately.
This topic review discusses the timing of renal transplantation and the optimal dialysis modality and prescription for patients who require dialysis either before or after transplantation.
Risk factors for graft failure in kidney transplantation are discussed elsewhere (see "Risk factors for graft failure in kidney transplantation"). Issues related to patient survival after transplantation and to the kidney transplant waiting list are discussed elsewhere (see "Patient survival after renal transplantation", section on 'Survival compared with dialysis' and "The kidney transplant waiting list in the United States"). The withdrawal of immunosuppression after a return to dialysis is discussed elsewhere. (See "Withdrawal of immunosuppression after renal transplant failure".)
TIMING OF TRANSPLANTATION
Preemptive transplantation — Preemptive transplantation is defined as elective transplantation prior to the initiation of chronic dialysis.
- Kasiske BL, Snyder JJ, Matas AJ, et al. Preemptive kidney transplantation: the advantage and the advantaged. J Am Soc Nephrol 2002; 13:1358.
- Meier-Kriesche HU, Port FK, Ojo AO, et al. Effect of waiting time on renal transplant outcome. Kidney Int 2000; 58:1311.
- Mange KC, Joffe MM, Feldman HI. Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med 2001; 344:726.
- Gill JS, Tonelli M, Johnson N, Pereira BJ. Why do preemptive kidney transplant recipients have an allograft survival advantage? Transplantation 2004; 78:873.
- Liem YS, Weimar W. Early living-donor kidney transplantation: a review of the associated survival benefit. Transplantation 2009; 87:317.
- Yoo SW, Kwon OJ, Kang CM. Preemptive living-donor renal transplantation: outcome and clinical advantages. Transplant Proc 2009; 41:117.
- Meier-Kriesche HU, Schold JD. The impact of pretransplant dialysis on outcomes in renal transplantation. Semin Dial 2005; 18:499.
- OPTN policy 3.5: Allocation of deceased kidneys. http://optn.transplant.hrsa.gov/PoliciesandBylaws2/policies/pdfs/policy_7.pdf (Accessed on July 25, 2013).
- Knoll G, Cockfield S, Blydt-Hansen T, et al. Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation. CMAJ 2005; 173:1181.
- Akkina SK, Connaire JJ, Snyder JJ, et al. Earlier is not necessarily better in preemptive kidney transplantation. Am J Transplant 2008; 8:2071.
- Grams ME, Massie AB, Coresh J, Segev DL. Trends in the timing of pre-emptive kidney transplantation. J Am Soc Nephrol 2011; 22:1615.
- National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39:S1.
- Goldfarb-Rumyantzev A, Hurdle JF, Scandling J, et al. Duration of end-stage renal disease and kidney transplant outcome. Nephrol Dial Transplant 2005; 20:167.
- Meier-Kriesche HU, Kaplan B. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation 2002; 74:1377.
- Wong G, Turner RM, Chapman JR, et al. Time on dialysis and cancer risk after kidney transplantation. Transplantation 2013; 95:114.
- Van Biesen W, Vanholder R, Lameire N. The role of peritoneal dialysis as the first-line renal replacement modality. Perit Dial Int 2000; 20:375.
- Goldstein A, Kliger AS, Finkelstein FO. Recovery of renal function and the discontinuation of dialysis in patients treated with continuous peritoneal dialysis. Perit Dial Int 2003; 23:151.
- Teitelbaum I, Burkart J. Peritoneal dialysis. Am J Kidney Dis 2003; 42:1082.
- Wauters JP, Uehlinger D. Non-medical factors influencing peritoneal dialysis utilization: the Swiss experience. Nephrol Dial Transplant 2004; 19:1363.
- Mendelssohn DC, Langlois N, Blake PG. Peritoneal dialysis in Ontario: a natural experiment in physician reimbursement methodology. Perit Dial Int 2004; 24:531.
- Tonelli M, Hemmelgarn B, Culleton B, et al. Mortality of Canadians treated by peritoneal dialysis in remote locations. Kidney Int 2007; 72:1023.
- Mehrotra R, Khawar O, Duong U, et al. Ownership patterns of dialysis units and peritoneal dialysis in the United States: utilization and outcomes. Am J Kidney Dis 2009; 54:289.
- Vats AN, Donaldson L, Fine RN, Chavers BM. Pretransplant dialysis status and outcome of renal transplantation in North American children: a NAPRTCS Study. North American Pediatric Renal Transplant Cooperative Study. Transplantation 2000; 69:1414.
- Cosio FG, Alamir A, Yim S, et al. Patient survival after renal transplantation: I. The impact of dialysis pre-transplant. Kidney Int 1998; 53:767.
- Binaut R, Hazzan M, Pruvot FR, et al. Comparative study of chronic ambulatory peritoneal dialysis versus hemodialysis patients after kidney transplantation: clinical and financial assessment. Transplant Proc 1997; 29:2428.
- Van Biesen W, Vanholder R, Van Loo A, et al. Peritoneal dialysis favorably influences early graft function after renal transplantation compared to hemodialysis. Transplantation 2000; 69:508.
- Vanholder R, Heering P, Loo AV, et al. Reduced incidence of acute renal graft failure in patients treated with peritoneal dialysis compared with hemodialysis. Am J Kidney Dis 1999; 33:934.
- Ojo AO, Hanson JA, Wolfe RA, et al. Dialysis modality and the risk of allograft thrombosis in adult renal transplant recipients. Kidney Int 1999; 55:1952.
- Passalacqua JA, Wiland AM, Fink JC, et al. Increased incidence of postoperative infections associated with peritoneal dialysis in renal transplant recipients. Transplantation 1999; 68:535.
- Chalem Y, Ryckelynck JP, Tuppin P, et al. Access to, and outcome of, renal transplantation according to treatment modality of end-stage renal disease in France. Kidney Int 2005; 67:2448.
- Goldfarb-Rumyantzev AS, Hurdle JF, Scandling JD, et al. The role of pretransplantation renal replacement therapy modality in kidney allograft and recipient survival. Am J Kidney Dis 2005; 46:537.
- Snyder JJ, Kasiske BL, Gilbertson DT, Collins AJ. A comparison of transplant outcomes in peritoneal and hemodialysis patients. Kidney Int 2002; 62:1423.
- Inrig JK, Sun JL, Yang Q, et al. Mortality by dialysis modality among patients who have end-stage renal disease and are awaiting renal transplantation. Clin J Am Soc Nephrol 2006; 1:774.
- Molnar MZ, Mehrotra R, Duong U, et al. Dialysis modality and outcomes in kidney transplant recipients. Clin J Am Soc Nephrol 2012; 7:332.
- Kramer A, Jager KJ, Fogarty DG, et al. Association between pre-transplant dialysis modality and patient and graft survival after kidney transplantation. Nephrol Dial Transplant 2012; 27:4473.
- Organ Procurement and Transplantation Network/Scientific Renal Transplant Registry. Annual data report 2003. Adjusted graft survival, deceased donor kidney transplants. www.unos.org (Accessed on March 11, 2005).
- McDonald RA, Smith JM, Stablein D, Harmon WE. Pretransplant peritoneal dialysis and graft thrombosis following pediatric kidney transplantation: a NAPRTCS report. Pediatr Transplant 2003; 7:204.
- Murphy BG, Hill CM, Middleton D, et al. Increased renal allograft thrombosis in CAPD patients. Nephrol Dial Transplant 1994; 9:1166.
- Robertson AJ, Nargund V, Gray DW, Morris PJ. Low dose aspirin as prophylaxis against renal-vein thrombosis in renal-transplant recipients. Nephrol Dial Transplant 2000; 15:1865.
- Van Loo AA, Vanholder RC, Bernaert PR, et al. Pretransplantation hemodialysis strategy influences early renal graft function. J Am Soc Nephrol 1998; 9:473.
- Kikić Z, Lorenz M, Sunder-Plassmann G, et al. Effect of hemodialysis before transplant surgery on renal allograft function--a pair of randomized controlled trials. Transplantation 2009; 88:1377.
- Bleyer AJ, Hartman J, Brannon PC, et al. Characteristics of sudden death in hemodialysis patients. Kidney Int 2006; 69:2268.
- Danovitch GM. Handbook of Kidney Transplantation, Lippincott Williams & Wilkins, Philadelphia 2010. Vol 5.
- Palevsky PM. Perioperative management of patients with chronic kidney disease or ESRD. Best Pract Res Clin Anaesthesiol 2004; 18:129.
- Montague BT, Ouellette JR, Buller GK. Retrospective review of the frequency of ECG changes in hyperkalemia. Clin J Am Soc Nephrol 2008; 3:324.
- Irish WD, Ilsley JN, Schnitzler MA, et al. A risk prediction model for delayed graft function in the current era of deceased donor renal transplantation. Am J Transplant 2010; 10:2279.
- Shoskes DA, Cecka JM. Deleterious effects of delayed graft function in cadaveric renal transplant recipients independent of acute rejection. Transplantation 1998; 66:1697.
- Irish WD, McCollum DA, Tesi RJ, et al. Nomogram for predicting the likelihood of delayed graft function in adult cadaveric renal transplant recipients. J Am Soc Nephrol 2003; 14:2967.
- Tapiawala SN, Tinckam KJ, Cardella CJ, et al. Delayed graft function and the risk for death with a functioning graft. J Am Soc Nephrol 2010; 21:153.
- Solak Y, Atalay H, Polat I, Yeksan M. CAPD-related peritonitis after renal transplantation. Perit Dial Int 2010; 30:596.
- Warren J, Jones E, Sener A, et al. Should peritoneal dialysis catheters be removed at the time of kidney transplantation? Can Urol Assoc J 2012; 6:376.
- Thomson BK, Moser MA, Marek C, et al. Peritoneal dialysis versus hemodialysis in patients with delayed graft function. Clin Transplant 2013; 27:E709.
- Kaplan B, Meier-Kriesche HU. Death after graft loss: an important late study endpoint in kidney transplantation. Am J Transplant 2002; 2:970.
- Rao PS, Schaubel DE, Jia X, et al. Survival on dialysis post-kidney transplant failure: results from the Scientific Registry of Transplant Recipients. Am J Kidney Dis 2007; 49:294.
- Meier-Kriesche HU, Baliga R, Kaplan B. Decreased renal function is a strong risk factor for cardiovascular death after renal transplantation. Transplantation 2003; 75:1291.
- de Jonge H, Bammens B, Lemahieu W, et al. Comparison of peritoneal dialysis and haemodialysis after renal transplant failure. Nephrol Dial Transplant 2006; 21:1669.
- Madar H, Korzets A, Ori Y, et al. Residual renal function in peritoneal dialysis after renal transplant failure. Perit Dial Int 2010; 30:470.
- Bernardo A, Fonseca I, Rodrigues A, et al. Predictors of residual renal function loss in peritoneal dialysis: is previous renal transplantation a risk factor? Adv Perit Dial 2009; 25:110.
- Arias M, Escallada R, de Francisco AL, et al. Return to dialysis after renal transplantation. Which would be the best way? Kidney Int Suppl 2002; :85.
- Chan MR, Oza-Gajera B, Chapla K, et al. Initial vascular access type in patients with a failed renal transplant. Clin J Am Soc Nephrol 2014; 9:1225.
- Zhang JC, Al-Jaishi A, Perl J, et al. Hemodialysis Arteriovenous Vascular Access Creation After Kidney Transplant Failure. Am J Kidney Dis 2015; 66:646.
- Woodside KJ, Schirm ZW, Noon KA, et al. Fever, infection, and rejection after kidney transplant failure. Transplantation 2014; 97:648.
- Perl J, Hasan O, Bargman JM, et al. Impact of dialysis modality on survival after kidney transplant failure. Clin J Am Soc Nephrol 2011; 6:582.
- Perl J, Dong J, Rose C, et al. Is dialysis modality a factor in the survival of patients initiating dialysis after kidney transplant failure? Perit Dial Int 2013; 33:618.
- Badve SV, Hawley CM, McDonald SP, et al. Effect of previously failed kidney transplantation on peritoneal dialysis outcomes in the Australian and New Zealand patient populations. Nephrol Dial Transplant 2006; 21:776.
- Andrews PA, Standards Committee of the British Transplantation Society. Summary of the British Transplantation Society Guidelines for Management of the Failing Kidney Transplant. Transplantation 2014; 98:1130.
- Wong G, Chua S, Chadban SJ, et al. Waiting Time Between Failure of First Graft and Second Kidney Transplant and Graft and Patient Survival. Transplantation 2016; 100:1767.
- Johnston O, Rose CL, Gill JS, Gill JS. Risks and benefits of preemptive second kidney transplantation. Transplantation 2013; 95:705.
- Goldfarb-Rumyantzev AS, Hurdle JF, Baird BC, et al. The role of pre-emptive re-transplant in graft and recipient outcome. Nephrol Dial Transplant 2006; 21:1355.
- TIMING OF TRANSPLANTATION
- Preemptive transplantation
- - Indications for preemptive transplantation
- - Exceptions to preemptive transplantation
- Glomerular filtration rate threshold for transplantation
- Patients already on dialysis
- DIALYSIS MODALITY BEFORE TRANSPLANTATION
- DIALYSIS IMMEDIATELY BEFORE TRANSPLANTATION
- DIALYSIS IMMEDIATELY AFTER TRANSPLANTATION
- CHRONIC DIALYSIS AFTER GRAFT FAILURE
- TIMING OF SECOND TRANSPLANTATION
- SUMMARY AND RECOMMENDATIONS