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Current Transplantation Reports

, Volume 5, Issue 3, pp 264–272 | Cite as

Perioperative Assessment and Intraoperative Core Concepts in the Complex Kidney Patient

  • Guy Efune
  • Cynthia Wang
  • M. Susan Mandell
  • The Scientific Advisory Council of the Society for the Advancement of Transplant Anesthesia
Anesthesia and Critical Care in Transplantation (D Axelrod and M Kaufman, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Anesthesia and Critical Care in Transplantation

Abstract

Purpose

Life span and sense of well-being continue to improve post-transplantation in patients with end-stage kidney disease, despite referral of an older and more medically complex population for transplantation. In this issue of the journal, we review existing evidence about risk assessment in kidney transplant candidates from the perspective of the anesthesiologist. The authors explore cardiovascular assessment and risk in the context of intraoperative events that can influence short- and long-term outcomes.

Recent Findings

The number of patients referred for kidney transplantation continues to increase and has far exceeded the number of donor organs available. Many of these patients have become more complex with higher rates of congestive heart failure, diabetes, obesity, collagen vascular disease, and end organ dysfunction. The risk of cardiovascular disease in the end-stage renal disease patient is higher than the general population, and many studies have looked at identifying which patients are higher risk for a post-transplant cardiovascular event. Despite this, tests to detect and guide interventions are not sensitive enough to prevent early cardiovascular complications leading to graft loss and patient death. To address this issue, we explore the strengths and limitations of current cardiovascular risk evaluation paradigms and add information about physiological events during transplant surgery that can affect short- and long-term patient and graft outcomes.

Summary

The overall survival of patients with end-stage renal disease has improved over time, but questions persist regarding best practices in the perioperative period. The approach to preoperative evaluation needs to be coherent with anticipated physiological events that occur during surgery. Filling in these gaps in knowledge may help improve the ability to identify and mitigate risk.

Keywords

Kidney transplantation Cardiovascular assessment Coronary artery disease Anesthetic considerations Intraoperative monitoring Intraoperative fluid management 

Notes

Compliance and Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Humans and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Guy Efune
    • 1
  • Cynthia Wang
    • 2
  • M. Susan Mandell
    • 3
  • The Scientific Advisory Council of the Society for the Advancement of Transplant Anesthesia
  1. 1.Department of Anesthesiology and Pain ManagementUT Southwestern Medical CenterDallasUSA
  2. 2.Department of Anesthesiology and Pain ManagementVA North Texas Healthcare SystemDallasUSA
  3. 3.Department of AnesthesiologyUniversity of ColoradoAuroraUSA

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