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Dialysis issues prior to and after renal transplantation

Vijaya Venkataraman, MD
Daniel C Brennan, MD, FACP
Brent W Miller, MD
Section Editor
Barbara Murphy, MB, BAO, BCh, FRCPI
Deputy Editor
Albert Q Lam, MD


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".)


Preemptive transplantation — Preemptive transplantation is defined as elective transplantation prior to the initiation of chronic dialysis.

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Literature review current through: Nov 2017. | This topic last updated: Dec 15, 2016.
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