Management of the peri-operative and critically ill renal transplant patient

Abstract

Summary Recipients of successful renal transplants experience a markedly improved quality of life and almost certainly improved survival compared to patients treated with dialysis. Haemodialysis treatment in the immediate period prior to transplantation is associated with a poorer outcome including a higher rate of delayed graft function (DGF). Individuals undergoing renal transplantation require close intra-operative monitoring with optimisation of intravascular fluid volume to maximise renal transplant perfusion. Whether mannitol, loop diuretics, dopamine or other therapies influence the rate of DGF is not possible to decide. For renal transplant recipients admitted immediately post-procedure to intensive care unit (ICU) the prognosis is good. This is in contrast to those admitted usually with overwhelming sepsis and concomitant acute kidney injury (AKI) late post-transplantation. An aggressive diagnostic strategy to ensure that co-infection is not missed is appropriate. The areas where consideration needs to be focused when managing renal transplant recipients on ICU include the fact that patients will have chronic kidney disease (CKD), the graft is more sensitive to the usual causes of AKI, central and peripheral venous access is often more problematic and immunosuppressive drug dosing often needs adjustment not only in the amount given but also the route of administration.