Perioperative management of the kidney transplant recipient

Abstract

Several aspects regarding perioperative management in kidney transplantation should be carefully considered, but the following three points need special attention: ① surgery performed under immunosuppressive therapy; ② sur-gery in patients with renal failure; and ③ acute rejection. Attention should be paid to infections because the im-mune function is suppressed by using an immunosuppressive agent. Prevention of infection is important because in-fections tend to become severe once they occur and may cause acute rejection. Both donors and recipients should be screened for infection prior to surgery, and it is important to focus on vaccination as much as possible. Patients with renal insufficiency (especially those who undergo living donor kidney transplants) suffer from diuresis relative-ly early after undergoing renal transplant surgery. Systemic management, including the control of blood pressure, is necessary, and the volume of urine output should be maintained with sufficient replacement fluid. The occurrence of acute rejection has decreased in recent years due to the advances in immunosuppressant therapy. However, renal transplantation in patients with high immunologic risk is still being carried out, and rejection is still an important as-pect of renal transplant surgery. Successful survival without any surgery will greatly affect the prognosis of the transplanted kidney; therefore, it is necessary to familiarize oneself with complications such as infections specific to transplant and acute rejection in order to manage unexpected events that may occur with immunosuppressive therapy.