Anesthesia for Kidney Transplant

Question 1

The most commonly performed transplant in the US, Europe & Asia is

Answer 1

kidney transplant

Question 2

Compared to HD, a kidney transplant is

Answer 2

more cost effective treatment

Question 3

There is a ________ vs. remaining on HD

Answer 3

40-60% decrease in death rate for kidney transplant

Question 4

The graft survival rate at 3 years for kidney transplant is

Answer 4

cadaveric- 88%

living donor- 93%

Question 5

Etiology of ESRD includes

Answer 5

diabetes (30-40%)
glomerulonephritis 
polycystic kidney disease
hypertensive kidney disease
chronic pyelonephritis
obstructive uropathy 
SLE
Alport's syndrome

Question 6

Alport’s syndrome is a

Answer 6

genetic disease that causes inherited nephritis in which people go into renal failure

Question 7

ESRD leads to a reduction in

Answer 7

GFR & urine output

Question 8

Patients with ESRD, develop UO of

Answer 8

<400 mL/day

oliguria

Question 9

ESRD is a ______ dysfunction

Answer 9

multi-system

Question 10

The major cause of death for ESRD

Answer 10

is CV disease; even after transplantation

Question 11

When GFR <30 mL/minute, the kidney

Answer 11

builds up nitrogenous waste

retains fluid & electrolytes- this can affect all of our organs

Question 12

Patients with ESRD often have

Answer 12

changes with potassium
retained fluid- CHF, pleural effusions
usually anemic
often have fragile bones

Question 13

Preoperative preparation for the renal transplant recipient includes

Answer 13

organ matching & allocation
preoperative evaluation
dialysis
immunosuppression & antibiotic protocol

Question 14

Pre-operative evaluation for the renal transplant recipient includes

Answer 14

ECG»» stress echo/cardiac cath
preoperative beta blockade- for cardiac protection
autonomic neuropathy–> diabetes, GERD–> considered full stomachs
CBC, lytes, coag profile- anemia, platelet dysfunction, more prone to bleeding

Question 15

Dialysis is performed preoperatively for the renal transplant recipient for

Answer 15

volume & electrolyte correction- dry weight, how many L they took off, may need to give fluid prior to induction as they may be dry

Question 16

Organ matching & allocation takes into account

Answer 16

ABO compatibility
HLA profile–> not done for all organs- typically kidneys, lungs, & pancreas
patient specific crossmatch- looking at reactive antibodies that recipient may have to the donor tissue

Question 17

Intraoperative anesthetic management for the renal transplant patient includes

Answer 17

standard monitors
Art/CVP based on patient comorbidities
GETA--> RSI b/c of full stomach
need good IV access
Balanced technique--> can use anything
Narcotic/volatile agents or TIVA
Cisatricurium is a good choice b/c of Hoffman elimination

Question 18

Fluids that can be used to intraoperatively manage the renal transplant patient include

Answer 18

Plasmalyte preferred or normal saline
CVP should be 10-15 mmHg
SBP >90, mean >60 mmHg

Question 19

All volatile agents

Answer 19

decrease renal blood flow to some degree & it is dose dependent
any of them can be used

Question 20

Monitoring for the renal transplant recipient should include

Answer 20

monitoring with reperfusion
monitor urine output
monitor for rejection

Question 21

When monitoring with reperfusion,

Answer 21

anticipate hypotension–> may turn volatile agent down, give volume, have pressors ready (don’t give phenyl, consider dopamine)

Question 22

Acute rejection requires

Answer 22

biopsy for diagnosis
would see things happening hemodynamically
hyperactue

Question 23

When monitoring urine output

Answer 23

monitoring for obstruction/irrigation–> maybe ureter is kinked or obstructed with clots
ultrasound diagnosis- thrombosis in anastomosis–> first 100 cc will be fluid they used to flush out the kidney
pharmacologic therapy–> mannitol, lasix, giving adequate volume

Question 24

Mannitol helps to protect

Answer 24

the kidney against oxygen free radicals that start to circulate

Question 25

Postoperative management of the renal transplant patient includes

Answer 25

analgesia- narcotics, PCA
combination blocks (intercostal, TAP)

Question 26

Kidney recipients will typically receive _____ prior to cross-clamping

Answer 26

heparin; not large enough dose that they will reverse it