Collaborative peri-transplant management of volume status, hypertension, and immunosuppression: enhancing kidney transplants for better outcomes.

This article explores the collaborative management of volume status, hypertension, and immunosuppression in kidney transplant patients to improve their outcomes. It discusses the risks associated with accepting marginal kidneys and the increasing rates of delayed or slow graft function. The article emphasizes the importance of multidisciplinary approaches to prevent complications such as hypertension, volume overload, and graft failure. It also discusses various methods for assessing volume status, including diagnostic techniques and ultrasonography. The article proposes a stepwise approach for managing volume status, hypertension, and immunosuppressive medications in the peri-transplant period. It also addresses the management of post-transplant patients with delayed or slow graft function, suggesting the potential benefits of once or twice weekly dialysis. The article highlights the importance of communication between community nephrologists and the transplant team and recommends the use of immediate-release calcineurin inhibitors over extended-release formulations. It acknowledges regional variations in dialysis laws and emphasizes the need for frequent clinical assessments for patients with delayed or slow graft function. Overall, the article provides a comprehensive management scheme for pre- and post-transplantation care and emphasizes the importance of personalized and collaborative approaches to optimize patient outcomes. [Extracted from the article]