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