Anesthetic Considerations for the Child Undergoing Transplantation

  • Peter G. Fuhr
  • Matthew S. Wilder
  • Alan R. Bielsky
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


Since the first kidney transplant, advancements in the care of solid organ transplant patients have included advancements in the intraoperative anesthetic care. Anesthesiologists specializing in the care of children undergoing solid organ transplant are integral members of the transplant team. Their experience and knowledge are an important part of the initial evaluation phase, the preoperative planning, intraoperative care, and postoperative care of this patient population.

Preoperatively, the pediatric transplant anesthesiologist performs an in-depth examination and evaluation of each patient. The combination of past medical history and current medical conditions helps to identify possible intraoperative challenges and plan for the safest possible intraoperative course.

Intraoperatively, the anesthesiologist is responsible for the overall care of the patient and is quick to respond to both the expected as well as unexpected changes in the patient’s medical condition. Each type of transplant has different stages during the operation. Close communication and a familiar operating room team are needed to ensure a smooth transition between stages as well as rapid response to unexpected events that are encountered during these difficult surgeries.

Postoperatively, the pediatric transplant anesthesiologist is an important part of transitioning the patient from an anesthetized state in the operating room to the team that will care for them during their recovery. Plans for pain control, respiratory support, and ongoing hemodynamic support are made and initiated by the anesthesiologist in the operating room.


Anesthesiology Liver Transplant Kidney Transplant Living-related donor Biliary Atresia Kasai hepatoportoenterostomy 


  1. Aggarwal S, Kang Y, Freeman JA et al (1987) Postreperfusion syndrome: cardiovascular collapse following hepatic reperfusion during liver transplantation. Transplant Proc 19:54–55PubMedGoogle Scholar
  2. American Society of Anesthesiologists Committee (2011) Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists Committee on standards and practice parameters. Anesthesiology 114:495–511CrossRefGoogle Scholar
  3. Bosilkovska M, Walder B, Besson M et al (2012) Analgesics in patients with hepatic impairment: pharmacology and clinical implications. Drugs 72:1645–1669. CrossRefPubMedGoogle Scholar
  4. Diamond IR, Fecteau A, Millis JM et al (2007) Impact of graft type on outcome in pediatric liver transplantation: a report from studies of pediatric liver transplantation (SPLIT). Ann Surg 246:301–310. CrossRefPubMedPubMedCentralGoogle Scholar
  5. Fullington NM, Cauley RP, Potanos KM et al (2014) Immediate extubation after pediatric liver transplantation: a single-center experience. Liver Transpl 21:57–62. CrossRefGoogle Scholar
  6. Gad EH, Abdelsamee MA, Kamel Y (2016) Hepatic arterial and portal venous complications after adult and pediatric living donor liver transplantation, risk factors, management and outcome (a retrospective cohort study). Ann Med Surg 8:28–39. CrossRefGoogle Scholar
  7. Gitlin JD (2003) Wilson disease. Gastroenterology 125(6):1868–1877CrossRefPubMedGoogle Scholar
  8. Mazzaferro V, Esquivel CO, Makowka L et al (1989) Hepatic artery thrombosis after pediatric liver transplantation – a medical or surgical event? Transplantation 47:971–977CrossRefPubMedGoogle Scholar
  9. Raffini L, Witmer C (2015) Pediatric transplantation: managing bleeding. J Thromb Haemost 13(Suppl 1):S362–S369. CrossRefPubMedGoogle Scholar
  10. Schmidt J, Kroeber S, Irouschek A et al (2006) Anesthetic management of patients with ornithine transcarbamylase deficiency. Paediatr Anaesth 16:333–337. CrossRefPubMedGoogle Scholar
  11. Soler X, Myo Bui CC, Aronson LA, Saied AS (2012) Current issues in pediatric liver transplantation. Int Anesthesiol Clin 50:54–65. CrossRefPubMedGoogle Scholar
  12. Spada M (2009) Pediatric liver transplantation. World J Gastroentrol 15:648–674. CrossRefGoogle Scholar
  13. Stellingwerff M, Brandsma A, Lisman T, Porte RJ (2012) Prohemostatic interventions in liver surgery. Semin Thromb Hemost 38:244–249. CrossRefPubMedGoogle Scholar
  14. Sunku B, Salvalaggio PRO, Donaldson JS et al (2006) Outcomes and risk factors for failure of radiologic treatment of biliary strictures in pediatric liver transplantation recipients. Liver Transpl 12:821–826. CrossRefPubMedGoogle Scholar
  15. Wan S, Roberts MA, Mount P (2016) Normal saline versus lower-chloride solutions for kidney transplantation. Cochrane Database Syst Rev:CD010741.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Peter G. Fuhr
    • 1
    • 3
  • Matthew S. Wilder
    • 2
  • Alan R. Bielsky
    • 2
  1. 1.Department of Pediatric AnesthesiologyChildren’s Hospital ColoradoAuroraUSA
  2. 2.Children’s Hospital Colorado and University of Colorado School of MedicineAuroraUSA
  3. 3.School of Medicine, University of ColoradoAuroraUSA

Section editors and affiliations

  • Tetsu Uejima
    • 1
  1. 1.Nemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA

Personalised recommendations