Anesthesia for renal transplantation

Renal transplantation is the preferred mode of replacement therapy for most patients with end-stage renal disease (ESRD) and accounts for nearly 60% of all organ transplants in the United States. While as many as 35,000 people remain on the list waiting to receive a cadaveric kidney, living-related renal transplantation offers a shorter waiting period and greater survival. Maximization of the health of the kidney recipient before transplantation can improve ultimate outcome. Proper anesthetic management is facilitated by understanding the physiology and pharmacology of ESRD. Maintaining intraoperative blood volume is a key to good graft function, especially the living-related pediatric kidney recipient. Recent improvements in combined immunosuppression therapy have improved the overall outcome in transplant recipients. The average 3-year survival is nearly 75%.