Intraoperative Management of the Kidney Transplant Recipient

Purpose of Review: The purpose of this study was to review current literature on the intraoperative management of the kidney transplant recipient in terms of preoperative evaluation, anesthetic agents of choice, monitoring needs, intraoperative fluid and hemodynamic management, and perioperative pain control options. Recent Findings: More recent literature regarding intraoperative kidney management suggests less aggressive volume loading with a balanced crystalloid solution, particularly in regard to albumin and blood products, with increased consideration for multimodal therapies for nausea and pain control. Summary: Perioperative kidney management is crucial to immediate- and long-term outcomes for graft and patient survival. Surgical and anesthetic techniques should continue to be honed to allow for ideal renal perfusion intraoperatively. Considerations for intraoperative optimization for renal transplantation include the appropriate types and volume of fluid based on cardiac risk factors with the increasing number of elderly recipients, the avoidance of vasoconstrictive agents, and a reduction in perioperative cardiac-depressing agents for pain that may be managed by multimodal therapies. © 2017, Springer International Publishing AG.