Improving outcomes after renal transplantation starts well before surgery - the role of renal replacement modality

More efficient immunosuppressive medication has markedly improved both graft and patient survival after renal transplantation. However, more potent immunosuppressants also have detrimental effects, such as increasing the risk of infection and cancer. Emphasis should therefore be placed on interventions that reduce the risk of rejection, graft dysfunction and patient death without increasing the immunosuppressive load. This has been clearly validated for better HLA matching between the donor and recipient, shorter cold ischemia times and improving organ preservation by machine perfusion.