Why is timing of hemodialysis important for renal transplantation?

Why is timing of hemodialysis important for renal transplantation?

By its very nature, cadaveric transplantation is more urgent than living donor transplantation. There is less pre-operative time for preparation and planning with cadaveric versus living related donor transplantation. The potential for hyperkalemia is an important consideration. Morbidity and mortality is improved by hemodialysis within 24 hours of surgery. If potassium (K⁺) levels are 6 mEq/L or greater, or if electrocardiogram (ECG) abnormalities exist, such as peaked T waves or cardiac dysrhythmias, it is prudent to perform dialysis prior to transplantation.

Intravascular volume overload is another important problem addressed by dialysis. Preoperative intravascular volume overload predisposes to congestive heart failure, which decreases cardiac output to the new kidney and complicates further volume loading used to prevent ischemia of the trans-planted organ. An average of 3–5 liters of crystalloid is required before renal artery and vein anastomoses. Associated uremic pericarditis further complicates fluid management and is another indication for preoperative dialysis.