SOME ASPECTS OF ANAESTHESIA FOR RENAL HOMOTRANSPLANTATION

Abstract

SUMMARY Thirty-six patients with chronic renal failure underwent homotransplantation of cadaver kidneys. Common problems were anaemia, hypertension, metabolic acidosis, raised blood urea levels, hyperkalaemia and hyponatraemia. Twenty-seven patients were treated with an immuno-suppressive drug (azathioprine) pre-operatively. Transplantation was the sole procedure in the first eight patients but, when possible thereafter, simultaneous transplantation and bilateral nephrectomy and splenectomy were performed. Several patients required further operations and four patients underwent a second transplantation. Anaesthesia was induced with thiopentone sodium or cyclopropane and oxygen, and maintained with halothane, nitrous oxide and oxygen. Suxamethonium was used in most patients. Ten patients have functioning transplants; two died from hyperkalaemia and one from cerebral cedema in the immediate postoperative period. The principal later cause of death was infection. Patients with functioning transplants may subsequently need surgery for an unrelated condition. Steroid and immuno-suppressive therapies are at present continued indefinitely, so that in this event extra steroid cover must be given and strict asepsis observed.