Kidney transplantation

Approximately 2000 kidney transplants are performed every year in the UK. Owing to advances in surgical technique and immunosuppression therapy, transplantation is now the preferred method of renal replacement therapy for most patients with established renal failure (ERF). Donor organs have traditionally been harvested from deceased heart-beating donors but other forms of donation (e.g. non-heart-beating donors and living donors) are increasingly being utilized. Patients with ERF have complex multisystem disease and are a high-risk group for anaesthesia and surgery. Cardiovascular disease is common and is the main cause of mortality following transplantation. Major preoperative considerations include evaluation of cardiorespiratory function and assessment of fluid and electrolyte balance. The main perioperative aim is to optimize graft function. Strategies include careful fluid management aided by central venous monitoring, maintenance of a mean arterial pressure of 70-80 mm Hg and administration of corticosteroid and mannitol around the time of graft reperfusion. Postoperative care is on a specialist ward and managed by protocols addressing fluid, pain and immunosuppression management. Living-donor kidney transplants now account for approximately one-third of all kidney transplants. Following a thorough evaluation process the living donor undergoes a unilateral nephrectomy performed either laparoscopically or as an open procedure.