Anaesthesia for renal transplant surgery: an update

Although the overall outcome of patients undergoing renal transplant surgery has improved in recent years, delayed graft function and myocardial infarction remain common and severe postoperative complications. This review article provides an update on anaesthesia for renal transplant surgery in order to optimise perioperative therapy and improve the outcome of these patients. In particular, the characteristics of this high-risk population and the recommendations for preoperative ‘work-up’ are summarised. Care for the living donor, commonly used drugs and their potential nephrotoxic properties are discussed. Finally, the current knowledge about volume therapy, optimised haemodynamic management and postoperative care is described.

[1]  N. Vaziri,et al.  Renal transplantation in the elderly , 2008, International Urology and Nephrology.

[2]  Jeroen J. Bax,et al.  Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery , 2009 .

[3]  C. Charpentier,et al.  [Anaphylactoid reactions to colloid plasma substitutes: incidence, risk factors, mechanisms. A French multicenter prospective study]. , 1994, Annales francaises d'anesthesie et de reanimation.

[4]  J. Schreuder,et al.  An evaluation of cardiac output by five arterial pulse contour techniques during cardiac surgery , 2007, Anaesthesia.

[5]  P. Alderson,et al.  Colloid solutions for fluid resuscitation. , 2012, The Cochrane database of systematic reviews.

[6]  R. Frumento,et al.  Intravenous fluid therapy in renal transplant recipients: results of a US survey. , 2002, Transplantation proceedings.

[7]  W. Weimar,et al.  Long-term consequences of kidney donation. , 2009, The New England journal of medicine.

[8]  R. Frumento,et al.  A Randomized, Double-Blind Comparison of Lactated Ringer’s Solution and 0.9% NaCl During Renal Transplantation , 2005, Anesthesia and analgesia.

[9]  A. Hartmann,et al.  Experience From an Active Preemptive Kidney Transplantation Program—809 Cases Revisited , 2009, Transplantation.

[10]  A. Zwinderman,et al.  Delayed graft function influences renal function, but not survival. , 2001, Kidney international.

[11]  V. Esnault,et al.  High-dose furosemide for established ARF: a prospective, randomized, double-blind, placebo-controlled, multicenter trial. , 2004, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[12]  A. Sagalowsky,et al.  Intraoperative albumin administration affects the outcome of cadaver renal transplantation. , 1992, Transplantation.

[13]  J. Farman,et al.  Suxamethonium hyperkalaemia in uraemic neuropathy , 1973, Anaesthesia.

[14]  Eld,et al.  COMPARISON OF MORTALITY IN ALL PATIENTS ON DIALYSIS , PATIENTS ON DIALYSIS AWAITING TRANSPLANTATION , AND RECIPIENTS OF A FIRST CADAVERIC TRANSPLANT , 2000 .

[15]  A. Hoitsma,et al.  MANNITOL AS AN INDISPENSABLE CONSTITUENT OF AN INTRAOPERATIVE HYDRATION PROTOCOL FOR THE PREVENTION OF ACUTE RENAL FAILURE AFTER RENAL CADAVERIC TRANSPLANTATION , 1987, Transplantation.

[16]  S. Albert,et al.  The effect of etomidate on adrenal function in critical illness: a systematic review , 2011, Intensive Care Medicine.

[17]  D. Fliser,et al.  Renal function in the elderly: impact of hypertension and cardiac function. , 1997, Kidney international.

[18]  K. Ikeda,et al.  Effects of Low‐flow Sevoflurane Anesthesia on Renal Function: Comparison with High‐flow Sevoflurane Anesthesia and Low‐flow Isoflurane Anesthesia , 1997, Anesthesiology.

[19]  A. Najafi,et al.  Effects of Normal Saline vs. Lactated Ringer's during Renal Transplantation , 2008, Renal failure.

[20]  T. Scheeren,et al.  Prognostic value of intraoperative renal tissue oxygenation measurement on early renal transplant function , 2009, Transplant international : official journal of the European Society for Organ Transplantation.

[21]  J. Martyn,et al.  Succinylcholine-induced Hyperkalemia in Acquired Pathologic States: Etiologic Factors and Molecular Mechanisms , 2006, Anesthesiology.

[22]  R. Hirose,et al.  Intraoperative Hyperglycemia Augments Ischemia Reperfusion Injury in Renal Transplantation: A Prospective Study , 2011, Journal of transplantation.

[23]  D. Gjertson,et al.  Outcomes of kidney transplantation from older living donors to older recipients. , 2008, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[24]  J. Joh,et al.  Is it safe to use a kidney from an expanded criteria donor? , 2011, Transplantation proceedings.

[25]  E. Murphy Acute Pain Management Pharmacology for the Patient with Concurrent Renal or Hepatic Disease , 2005, Anaesthesia and intensive care.

[26]  J. Hunter,et al.  Disposition of infusions of atracurium and its metabolite, laudanosine, in patients in renal and respiratory failure in an ITU. , 1988, British journal of anaesthesia.

[27]  S. Teixeira,et al.  Sevoflurane versus isoflurane: does it matter in renal transplantation? , 2007, Transplantation proceedings.

[28]  J. H. Harrison,et al.  Successful homotransplantation of the kidney in an identical twin. , 1955, Transactions of the American Clinical and Climatological Association.

[29]  I. Davidson Renal impact of fluid management with colloids: a comparative review , 2006, European journal of anaesthesiology.

[30]  M. Laxenaire,et al.  Réactions anaphylactoïdes aux substituts colloïdaux du plasma : incidence, facteurs de risque, mécanismes. Enquête prospective multicentrique française , 1994 .

[31]  J. Jeekel,et al.  A controlled study on the effect of mannitol on immediate renal function after cadaver donor kidney transplantation. , 1983, Transplantation.

[32]  K. Kijvikai,et al.  Comparative outcomes of open nephrectomy, hand-assisted laparoscopic nephrectomy, and full laparoscopic nephrectomy for living donors. , 2012, Transplantation proceedings.

[33]  P. Coriat,et al.  Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients , 1996, The Lancet.

[34]  T. Sulikowski,et al.  Influence of perioperational acid-base balance disorders on early graft function in kidney transplantation. , 2007, Transplantation proceedings.

[35]  A. Rodríguez–Carmona,et al.  A comparison of transplant outcomes in peritoneal and hemodialysis patients. , 2003, Kidney international.

[36]  A. Dınçkan,et al.  The Effect of Different Crystalloid Solutions on Acid-Base Balance and Early Kidney Function After Kidney Transplantation , 2008, Anesthesia and analgesia.

[37]  K. Peter,et al.  Renal Function and Serum Fluoride Concentrations in Patients with Stable Renal Insufficiency After Anesthesia with Sevoflurane or Enflurane , 1995, Anesthesia and analgesia.

[38]  J. Ornato,et al.  [ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery]. , 2009, Masui. The Japanese journal of anesthesiology.

[39]  J. Driessen,et al.  Reduced clearance of rocuronium and sugammadex in patients with severe to end-stage renal failure: a pharmacokinetic study. , 2010, British journal of anaesthesia.

[40]  Anshi Wu,et al.  Effects of the novel 6% hydroxyethyl starch 130/0.4 on renal function of recipients in living-related kidney transplantation. , 2010, Chinese medical journal.

[41]  K. Lopau,et al.  Prospective Age‐Matching in Elderly Kidney Transplant Recipients—A 5‐Year Analysis of the Eurotransplant Senior Program , 2007, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[42]  B. Kasiske,et al.  Acute myocardial infarction and kidney transplantation. , 2006, Journal of the American Society of Nephrology : JASN.

[43]  C. Tomson Chapter 1: Summary of findings in the 2009 UK Renal Registry Report , 2010, Nephron Clinical Practice.

[44]  J. Hunter,et al.  Pharmacokinetics and pharmacodynamics of the three isomers of mivacurium in health, in end-stage renal failure and in patients with impaired renal function. , 1995, British journal of anaesthesia.

[45]  P. Marik Low-dose dopamine: a systematic review , 2002, Intensive Care Medicine.

[46]  M. Hübler,et al.  Renal Responses to Desflurane and Isoflurane in Patients with Renal Insufficiency , 2002, Anesthesiology.

[47]  D. Gommers,et al.  Comparison of three perioperative fluid regimes for laparoscopic donor nephrectomy , 2007, Surgical Endoscopy.

[48]  R. Miller,et al.  The Pharmacokinetics and Pharmacodynamics of Atracurium in Patients with and without Renal Failure , 1984, Anesthesiology.

[49]  G. Chertow,et al.  Beyond Framingham: cardiovascular risk profiling in ESRD. , 2005, Journal of the American Society of Nephrology : JASN.

[50]  A. Hoitsma,et al.  Prevention of Acute Tubular Necrosis in Cadaveric Kidney Transplantation by the Combined Use of Mannitol and Moderate Hydration , 1985, Annals of surgery.

[51]  Rolf Rossaint,et al.  Intensive insulin therapy and pentastarch resuscitation in severe sepsis. , 2008, The New England journal of medicine.

[52]  R. Wolfe,et al.  Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates. , 2001, Journal of the American Society of Nephrology : JASN.

[53]  K. Klouche,et al.  Outcome of Renal Transplant Recipients Admitted to an Intensive Care Unit: A 10-Year Cohort Study , 2009, Transplantation.

[54]  L. Perrone,et al.  Perioperative fluid management in kidney transplantation: is volume overload still mandatory for graft function? , 2006, Transplantation proceedings.

[55]  A. Gaber,et al.  Changes in gastric emptying in recipients of successful combined pancreas-kidney transplants. , 1991, Digestive diseases.

[56]  A. Ismael,et al.  The Impact of Timing of Maximal Crystalloid Hydration on Early Graft Function During Kidney Transplantation , 2010, Anesthesia and analgesia.

[57]  Arzu Ozturk,et al.  Single-dose thymoglobulin induction in living-donor renal transplantation. , 2011, Annals of transplantation.

[58]  J. Kellum,et al.  Use of dopamine in acute renal failure: A meta-analysis , 2001, Critical care medicine.

[59]  E. Bronzatto,et al.  Delayed graft function in renal transplant recipients: risk factors and impact on 1-year graft function: a single center analysis. , 2009, Transplantation proceedings.

[60]  J. Hunter,et al.  Pharmacokinetics of 1R-cis 1'R-cis atracurium besylate (51W89) and plasma laudanosine concentrations in health and chronic renal failure. , 1995, British journal of anaesthesia.

[61]  J. Wierda,et al.  Time course of neuromuscular effects and pharmacokinetics of rocuronium bromide (Org 9426) during isoflurane anaesthesia in patients with and without renal failure. , 1993, British journal of anaesthesia.

[62]  Tom Chan,et al.  Identifying patients with chronic kidney disease from general practice computer records. , 2005, Family practice.

[63]  R. Landgraf,et al.  Measurement of transit disorders in different gastrointestinal segments of patients with diabetes mellitus in relation to duration and severity of the disease by use of the metal-detector test. , 1995, Zeitschrift fur Gastroenterologie.

[64]  T. Steinman,et al.  Renal failure following enflurane anesthesia. , 1976, Anesthesiology.

[65]  B. Lindholm,et al.  Influence of different treatments and schedules on the factors conditioning the nutritional status in dialysis patients. , 1998, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[66]  Cecka Jm The OPTN/UNOS renal transplant registry. , 2005 .

[67]  C. Carpenter Blood transfusion effects in kidney transplantation. , 1990, The Yale journal of biology and medicine.

[68]  R. Wolfe,et al.  The Report of a National Conference on the Wait List for Kidney Transplantation , 2003, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[69]  J. Cecka,et al.  The OPTN/UNOS renal transplant registry. , 2004, Clinical transplants.

[70]  T. Sacco,et al.  Balanced anestesia versus total intravenous anestesia for kidney transplantation. , 2006, Minerva anestesiologica.

[71]  A. Sagalowsky,et al.  The effect of intraoperative fluid management on the incidence of acute tubular necrosis. , 1987, Transplantation proceedings.

[72]  D. Ansell UK Renal Registry 11th Annual Report (December 2008): Chapter 1 Summary of findings in the 2008 UK Renal Registry Report , 2009, Nephron Clinical Practice.

[73]  A. Artru,et al.  Low-flow sevoflurane compared with low-flow isoflurane anesthesia in patients with stable renal insufficiency. , 2002, Anesthesiology.

[74]  L. Ratner,et al.  Early hemodynamic changes after renal transplantation: determinants of low central venous pressure in the recipients and correlation with acute renal dysfunction. , 2003, Medical science monitor : international medical journal of experimental and clinical research.

[75]  J. Perry,et al.  Rocuronium versus succinylcholine for rapid sequence induction intubation. , 2008, The Cochrane database of systematic reviews.

[76]  S. Takemoto,et al.  Patient and Graft Outcomes from Deceased Kidney Donors Age 70 Years and Older: An Analysis of the Organ Procurement Transplant Network/United Network of Organ Sharing Database , 2008, Transplantation.

[77]  R. Bellomo,et al.  Vasoactive drugs and acute kidney injury , 2008, Critical care medicine.

[78]  J. Driessen,et al.  Multicentre, parallel-group, comparative trial evaluating the efficacy and safety of sugammadex in patients with end-stage renal failure or normal renal function. , 2008, British journal of anaesthesia.

[79]  A. Di Filippo,et al.  Low-dose dopamine in kidney transplantation. , 2009, Transplantation proceedings.

[80]  J. Ornato,et al.  ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation , 2007, Circulation.

[81]  M. Bartels,et al.  Is perioperative low molecular weight hydroxyethyl starch infusion a risk factor for delayed graft function in renal transplant recipients? , 2011, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[82]  P. Peeters,et al.  Hydroxyethyl starch does not impair immediate renal function in kidney transplant recipients: a retrospective, multicentre analysis. , 1999, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[83]  A Buscaroli,et al.  The influence of intraoperative central venous pressure on delayed graft function in renal transplantation: a single-center experience. , 2010, Transplantation proceedings.

[84]  M. Allison,et al.  Loop diuretics in the management of acute renal failure: a prospective, double-blind, placebo-controlled, randomized study. , 1997, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[85]  A. Tuzuner,et al.  Pure laparoscopic versus open live donor nephrectomy: evaluation of health survey and graft functions. , 2011, Transplantation proceedings.

[86]  P. Prokocimer,et al.  Inhalation Toxicity Study of a Haloalkene Degradant of Sevoflurane, Compound A (PIFE), in Sprague‐Dawley Rats , 1995, Anesthesiology.

[87]  Michael Baram,et al.  Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. , 2008, Chest.

[88]  R. Strauss,et al.  An international view of hydroxyethyl starches , 1999, Intensive Care Medicine.

[89]  C. Niemann,et al.  Abdominal organ transplantation. , 2010, Minerva anestesiologica.

[90]  K. Tantivitayatan,et al.  A comparison of the efficacy of cisatracurium and atracurium in kidney transplantation operation. , 2004, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[91]  W. Winkelmayer,et al.  Effect of Hemodialysis Before Transplant Surgery on Renal Allograft Function—A Pair of Randomized Controlled Trials , 2009, Transplantation.

[92]  E. Eger,et al.  Toxicity of Compound A in Rats: Effect of a 3‐Hour Administration , 1994, Anesthesiology.

[93]  E. Eger,et al.  Toxicity of Compound A in Rats: Effect of Increasing Duration of Administration , 1994, Anesthesiology.