Update on the intraoperative management of adult cadaveric renal transplantation

Abstract

### Key points Renal transplantation is increasing with 1930 transplants undertaken in the UK in 2013 compared with 1308 in 2005. This increase follows the NHS Blood and Transplant (NHSBT) ‘Organs for Transplant’ initiative, and should continue rising as part of their ‘Taking Organ Transplant to 2020’ programme. Renal transplantation confers almost immediate improvements in quality of life and improves morbidity and mortality compared with dialysis. There are also fiscal gains to the healthcare provider: renal transplantation being cheaper than ongoing dialysis. However, graft implantation is a complex surgical procedure with both short- and long-term outcomes directly attributable to intraoperative physiological status.1,2 In future there will be a need to anaesthetize more elderly recipients, with more extensive comorbidities. This article will discuss anaesthesia for implantation of cadaveric kidneys; alternative sources within this journal have discussed live related donor surgery in detail.3 ### Comorbid illness The commonest aetiology of renal dysfunction in the UK is diabetes mellitus, with an increasing prevalence since 2006 and projected to be 14 000 patients in 2014–15. This and other causes of end-stage renal failure (ESRF), such as IgA nephropathy and hypertension, each pose their own anaesthetic challenges. Chronic kidney disease (CKD) is classified using glomerular filtration rate (GFR) to quantify the …