Longnecker's Anesthesiology > Part 4. Managing Anesthesia Care > Section E. Specialty Areas of Anesthetic Practice > Chapter 58. Anesthesia for Kidney, Pancreas, or Other Organ Transplantation David S. Beebe, MD, and Kumar G. Belani, MBBS, MS

Key Points

"1. Half of all deaths after renal transplantation are cardiac related, and cardiac disease is the leading cause of death in the first year posttransplant. Therefore, detection of severe coronary artery disease in patients prior to transplantation is vital.

2. Diabetics with autonomic neuropathy are at risk for severe hypotension and bradycardia during induction of general anesthesia and for sudden death in the postoperative period.

3. Blood glucose levels should be determined every hour in renal transplant recipients who have insulin-dependent diabetes mellitus. Evidence suggests that the incidence of wound infections in diabetic patients can be reduced if blood sugar levels are tightly controlled.

4. Patients undergoing renal transplantation usually benefit from central venous pressure measurement, which helps determine if the patient's volume status is adequate at the time of reperfusion of the allograft.

5. To ensure adequate volume expansion in adult kidney recipients, central venous pressure should be raised to 14 or 15 mm Hg with intravenous normal saline or 5% albumin prior to perfusion of the allograft. If the patient is relatively anemic (hemoglobin <10 g/dL), packed red blood cells can be used for this purpose as well.

6. Hypotension can result in decreased graft perfusion and delayed graft function in adult kidney recipients...."