Organ Transplantation

This chapter describes perioperative management relevant to kidney, liver, heart, lung, and pancreas transplantation. Because of the shortage of donor organs, candidates who are accepted for transplantation may wait a year or more before a suitable organ is available. Prelisting assessments may be outdated by then, so testing may need to be repeated or supplemented. Because of the prevalence of hypertension, diabetes, and age-related comorbidities, cardiovascular risk must be carefully evaluated in transplant candidates. Preoperatively, laboratory values are reviewed, and procedures such as dialysis may be indicated. Intraoperative anesthetic considerations reflect the organ being transplanted, the patient's comorbidities, anticipated blood loss, and the effects of specific organ dysfunction on anesthetic pharmacokinetics and pharmacodynamics. Intravascular fluid balance is maintained while avoiding anemia, coagulopathy, electrolyte imbalance, and acid-base disturbances. Reperfusion of the graft is an important intraoperative event that can be associated with abrupt decreases in systemic vascular resistance, acidosis, hyperkalemia, and hypothermia. Assessment of graft function begins intraoperatively and continues into the postoperative period.