Abdominal Aortic Aneurysm Surgery in Renal, Cardiac and Hepatic Transplant Recipients

With advancements in transplantation and improved long-term allograft survival, the once rare clinical scenario of an abdominal aortic aneurysm (AAA) in a patient with a functioning allograft has become much more frequent. In transplant recipients, AAA repair has the potential to cause irreversible ischaemic injury to the transplanted organ. Different case series and case reports have mentioned a variety of techniques to offer protection to the transplanted organs during aneurysm repair such as cold perfusion, shunting, temporary surgical bypass and extracorporeal circuits etc. Critical review of these adjuncts seems to suggest that that they do not give any better results than just using a “clamp and go” approach. Endovascular aneurysm repair (EVAR) may offer some advantages for transplant patients who have suitable anatomy for endovascular stent deployment. In addition to these surgical techniques, various aspects of medical management for renal, cardiac and hepatic transplant recipients undergoing AAA repair are discussed.