Anesthesia for Kidney Transplant Flashcards
The most commonly performed transplant in the US, Europe & Asia is
kidney transplant
Compared to HD, a kidney transplant is
more cost effective treatment
There is a ________ vs. remaining on HD
40-60% decrease in death rate for kidney transplant
The graft survival rate at 3 years for kidney transplant is
cadaveric- 88%
living donor- 93%
Etiology of ESRD includes
diabetes (30-40%) glomerulonephritis polycystic kidney disease hypertensive kidney disease chronic pyelonephritis obstructive uropathy SLE Alport's syndrome
Alport’s syndrome is a
genetic disease that causes inherited nephritis in which people go into renal failure
ESRD leads to a reduction in
GFR & urine output
Patients with ESRD, develop UO of
<400 mL/day
oliguria
ESRD is a ______ dysfunction
multi-system
The major cause of death for ESRD
is CV disease; even after transplantation
When GFR <30 mL/minute, the kidney
builds up nitrogenous waste
retains fluid & electrolytes- this can affect all of our organs
Patients with ESRD often have
changes with potassium
retained fluid- CHF, pleural effusions
usually anemic
often have fragile bones
Preoperative preparation for the renal transplant recipient includes
organ matching & allocation
preoperative evaluation
dialysis
immunosuppression & antibiotic protocol
Pre-operative evaluation for the renal transplant recipient includes
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
Dialysis is performed preoperatively for the renal transplant recipient for
volume & electrolyte correction- dry weight, how many L they took off, may need to give fluid prior to induction as they may be dry
Organ matching & allocation takes into account
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
Intraoperative anesthetic management for the renal transplant patient includes
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
Fluids that can be used to intraoperatively manage the renal transplant patient include
Plasmalyte preferred or normal saline
CVP should be 10-15 mmHg
SBP >90, mean >60 mmHg
All volatile agents
decrease renal blood flow to some degree & it is dose dependent
any of them can be used
Monitoring for the renal transplant recipient should include
monitoring with reperfusion
monitor urine output
monitor for rejection
When monitoring with reperfusion,
anticipate hypotension–> may turn volatile agent down, give volume, have pressors ready (don’t give phenyl, consider dopamine)
Acute rejection requires
biopsy for diagnosis
would see things happening hemodynamically
hyperactue
When monitoring urine output
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
Mannitol helps to protect
the kidney against oxygen free radicals that start to circulate
Postoperative management of the renal transplant patient includes
analgesia- narcotics, PCA combination blocks (intercostal, TAP)
Kidney recipients will typically receive _____ prior to cross-clamping
heparin; not large enough dose that they will reverse it
