Anesthesia For Kidney Transplant
Anesthesia For Kidney Transplant
Anesthesia For Kidney Transplant
Ans:
Definition:
o Cold ischemic time: the time when kidney is cooled with cold
perfusion solution and ends after organ reaches physiological
temperature during implantation procedures.
o Warm ischemic time:
Donor: after the application of clamp beginning of cold
storage.
Recepient: After the initiation of circulatory arrest to
anastomosis of veins.
o Longer ischemic times associated with higher incidence of delayed
graft function.
Management of transplant depends on: cadaveric or living donor.
Cadaveric kidney:
o Preparation of recipient and optimization
o Short preparation time
o High induction dose of immune-modulative drugs
o PAC:
CV system instability:
Upto 25% of patient at risk of having CAD full CV
workup needed
o The incidence of longer ischemia times is high.
o Considerations for emergency surgery acid prophylaxis
o Correction of preexisting derangements:
Acidosis
Azotaemia
Anemia
Electrolyte disturbance: chloride, calcium, potassium
Fluids: hypovolemia and hypotension post extraction
dialysis; Mannitol and diuretics
Thymoglobulin infusion: accentuates hypotension if given at
high rates
o Intraop:
Hypothermia: d/t cold perfusion
Fluid: type and amount of fluid infused
o Methylprednisolone: infusion during anastomosis and it
completion before reperfusion
o Reperfusion of grafted kidney
o Goals of management:
Early immunosuppressive therapy
Adequate volume
Adequate perfusion pressure
Avoidance of vasopressors as far as possible
Achieving short cold ischemic time as possible.
Living renal transplant
o Considerations both for donor and recipient
o Elective surgery
o Preparation starts months before: selection of donor,
optimization and assessment
o Immunosuppressive therapy started few days prior
o Preparation for Donor:
ASA I and II
Full preop assessment
ABO blood group, tissue typing, leucocyte crossmatch
Inv: CBC, Coagulation profile, RFT, FBS, viral markers
including CMV, lipid profile, urine R/E and C/S, CXray, ECG
>50 yrs: colonoscopy
>40 yrs female: mammogram
Pap test and pelvic exam for females
Mantoux test for TB
o Organ matching:
Major blood group compatibility (ABO)
HLA profile
Preformed reactive antibodies (PRA) against donor antigens
o Preparation for Recepient:
Investigations: CBC, platelet, electrolytes, glucose, RFT,
urine, ECG, CXRay, Echo
Coagulation profile
ABG
Screening for HCV, HIC, CMV
Pneumococcal, meningococcal and HIB vaccination
Immunosuppression strategies aim to prevent graft
rejection