Hello everyone! I have a question that I would appreciate if you could help me answer. The use of dialysis in renal transplantation is considered for the treatment of delayed graft function or severe hyperkalemia. Within the Clavien Dindo classification of complications, it would be considered within category IVa. Is this assessment correct? Should the use of dialysis be considered a serious complication in transplantation? Thank you for your time
I would say it depends.
While the currently accepted definition of delayed graft function is the need for dialysis within the first week after kidney transplant, it lacks specificity in terms of predicting outcomes.
Intuitively, 1 session of dialysis post transplant for hyperkalemia is different than the need for ongoing dialysis.
The question then is what is the underlying cause leading to the need for dialysis? Is it reversible or transient (perioperative hyperkalemia) or a more sustained injury, such as acute tubular necrosis or rejection?
Efforts to diagnose the underlying cause are paramount to best manage. This includes vascular imaging of the graft to insure adequate flow as well as serial biopsies if not seeing recovery.
In sum dialysis can be a serious complication if the underlying cause leads to graft dysfunction or in worse case, primary non-function.
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