Principles of renal access surgery and transplantation

The treatment of end stage renal failure is renal replacement therapy. This may be by dialysis (blood or peritoneal) or by kidney transplantation. The outlook for those who have a successful renal transplant has improved significantly over the past 20 years: graft survival from non-heart-beating donation is now a mean of 14 years, and 18 years for live donor transplants.Unfortunately the number of renal transplants fails to meet the demand from patients on the transplant waiting list. The shortfall has to be managed by dialysis. Life expectancy of a patient on haemodialysis is one-fifth to one-quarter of that of the age-matched healthy population, but doubles following successful transplantation.The predominant type of dialysis is blood dialysis. To provide this, patients require a portal of access to the circulation. This patient group requires timely and well-planned renal access surgery. Circulatory access is their lifeline. Failure of access, coupled with the need for emergency admission, is a major cause of morbidity and mortality.