Introduction: Known short term consequences of hemodialysis (HD) include hypotension and increased risk of cardiovascular events due to electrolyte imbalances. Little is known of its effects on kidney transplantation in this acute setting. We wanted to see if HD immediately before transplantation has an effect on the short-term graft outcomes.
Material: This is a single centre retrospective analysis of deceased donor kidney transplants between 2019 to 2023. Only patients with in-centre HD were included. Data was collected on the last pre-operative HD sessions, donor and recipient factors. The outcomes measures (delayed graft function, serum creatinine up to 3 months and complications) were stratified according to the time lapse between HD session to the initiation of surgery. 
Results: 230 patients were included. 137 were males and the mean age was 54.89±11.40 years. The mean duration of HD was 204±43.29 minutes and the mean volume removed was 1.932±0.9820 litters. 106 patients developed delayed graft function and received at least 1 HD session post-operatively. The mean time from the HD to the initiation of transplantation was 1589±1013 minutes. No statistically significant effect was observed on the delayed graft function when the HD cut off was 3,6,12 or 24 hours from the initiation of the transplantation (p 0.3158, p 0.7548, p 0.0827 and p 0.7941 respectively); 4- and 12-weeks post-transplant function was also not significantly different.
Conclusion: Although HD can significantly alter the hemodynamic parameters of the patients before an operation, we couldn’t elicit any direct relationship with the short-term post-transplant outcomes. Hence, pre-transplant HD appears safe even when instituted soon before the surgery.