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
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
- 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.
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- 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