Effect of hemodialysis before transplant surgery on renal allograft function--a pair of randomized controlled trials.
BACKGROUND
Hemodialysis immediately before kidney transplant surgery has been suggested to adversely affect early graft function. On the other hand, considering its profound antiinflammatory effects, a beneficial impact of regional citrate anticoagulation on the evolution of graft function can be speculated. We sought to assess the clinical impact of preoperative hemodialysis and dialysis anticoagulation in two related randomized trials.


METHODS
Eligible kidney transplant candidates with a serum potassium less than or equal to 5.0 mEq/L were randomized to receive dialysis or no dialysis before deceased donor transplantation. Patients with a potassium more than 5.0 mEq/L were randomized to receive dialysis with heparin or citrate anticoagulation. The primary endpoint was the estimated glomerular filtration rate (eGFR) at posttransplant day 5.


RESULTS
The first comparison (56 vs. 54 patients) revealed no effect of dialysis on eGFR at day 5 (primary endpoint, 12 [interquartile range 5-36] vs. 13 [5-37] mL/min/1.73 m2, P=0.98), rates of delayed graft function (22% vs. 27%, P=0.66), cellular rejection (20% vs. 24%, P=0.65), and C4d-positive dysfunction (2% vs. 9%, P=0.11) or 1-year death-censored graft survival (89% vs. 91%, P=0.51). Comparing citrate with heparin anticoagulation (44 vs. 66 patients), no differences in eGFR at day 5 (17 [8-31] vs. 14 [6-38] ml/min/1.73 m2, P=0.57), delayed graft function (21% vs. 30%, P=0.28), cellular rejection (23% vs. 33%, P=0.29), and graft survival (90% vs. 88%, P=0.44) were found. For citrate anticoagulation, less C4d-positive rejection episodes (P=0.08) and higher 1-year eGFR levels (P=0.03) were observed.


CONCLUSIONS
Pretransplant hemodialysis and anticoagulation may not affect early graft function in a meaningful way.
Kikić
Zeljko
Z
Department of Medicine III, Medical University of Vienna, Vienna, Austria.
Lorenz
Matthias
M
Sunder-Plassmann
Gere
G
Schillinger
Martin
M
Regele
Heinz
H
Györi
Georg
G
Mühlbacher
Ferdinand
F
Winkelmayer
Wolfgang C
WC
Böhmig
Georg A
GA
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods*; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome