Kidney Transplantation

Patients with end-stage renal disease (ESRD) can be managed with kidney transplantation, hemodialysis, or peritoneal dialysis. The most common organ transplanted in the United States is the kidney. Kidney transplantation surgery can be divided into the following stages: incision/dissection of vessels, cross-clamping vessels, vascular anastomosis, unclamping of vessels, ureter anastomosis to bladder, and closing. The size of recipient and donor kidneys as well as the size of recipient blood vessels will determine the position of graft implantation—either intraperitoneal or extraperitoneal. At the conclusion of surgery, most of the patients are extubated. This chapter describes the key steps in the preoperative assessment, explains the features of intraoperative anesthetic management, reviews the risk factors for reintubation, and identifies the optimal plan for postoperative pain management.