Perioperative considerations for kidney and pancreas-kidney transplantation

Publication date: Available online 22 January 2020Source: Best Practice & Research Clinical AnaesthesiologyAuthor(s): Beatriz Tena, Marina VendrellSummaryKidney transplantation is the treatment of choice in patients with end-stage renal disease, as it improves survival and quality of life. Living donor kidney transplant prior to pancreas transplantation, or simultaneous pancreas and kidney transplantation are also discussed.Patients usually present comorbidities, and extensive preoperative workups are recommended, especially cardiac assessment, though type and frequency of surveillance is not established.Nefroprotective strategies include adequate fluid status and goal-directed therapy. The classical use of diuretics has not demonstrated a real nefroprotective effect at follow-up. Thromboprophylaxis regimes, especially for the pancreatic graft outcome, are of importance.Of note, transplantation in the obese population has increased in the last decades. Strict preoperative evaluation and pulmonary considerations must be kept in mind.Finally, robotic kidney transplant is a recent approach that presents anesthetic challenges, mainly related to steep Trendelemburg position and fluid restriction.

Source: Best Practice and Research Clinical Anaesthesiology - January 22, 2020 Category: Anesthesiology Source Type: research