Anesthesia management of renal transplantation: an update

Abstract

End stage renal disease pool is ever increasing in India due to increased prevalence of type 2 diabetes mellitus which is often detected late when macrovascular and microvascular complications of glycosylated haemoglobin have already set in. Postoperative cardiac surgical patient also land up in ESRD as a sequelae of acute renal failure due to poor perioperative optimization and inadequate control of blood pressure before surgery. Sensitization and awareness created by NOTTO, ROTTO, SOTTO has increased the donor pool especially from deceased brain stem dead donors and more and more donors are available to the ESRD patients in the wait list waiting for organ transplantation. The anesthesiologist plays a pivotal role in coordinating the transplantation programme minimizing transplantation time after organ retrieval to ensure maximal graft survival. The challenges faced by the anesthesiologists in conducting the renal transplant are numerous due to multiorgan affection of the ESRD patient as well as potential drug interaction with the anesthetic agents due to intensive immunosuppressant therapy.