Anaes · Perioperative medicine
Anaesthesia for the solid organ transplant recipient
Also known as Post-transplant nontransplant surgery · Immunosuppression anaesthesia · Kidney liver heart lung recipient GA
Exam-pass anaesthesia for solid organ transplant recipients having non-transplant surgery: graft function, immunosuppression drug interactions, infection risk, physiology by organ, and multidisciplinary planning.
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Target exams
Red flags
- Never stop critical immunosuppressants casually without transplant team advice.
- Sepsis may present subtly in immunosuppressed patients.
- Nephrotoxic and CYP-interacting drugs can injure graft or spike calcineurin levels.
- Stress-dose steroids may be needed if recent high-dose glucocorticoids.
- Aspiration and difficult physiology differ by organ transplanted.
Meet the patient
A 55-year-old kidney transplant recipient on tacrolimus, mycophenolate, and prednisolone arrives for an emergency laparotomy. The graft works, the creatinine is at his baseline, and he looks well — but question examiner is really asking is whether you will protect the graft, keep the immunosuppression running, and catch the sepsis that hides behind the immunosuppression. Three principles decide the case: know the graft, know the drugs, and distrust the absence of fever.[1]
The exam is never "redo the original transplant". It is graft protection, drug interactions, infection, and organ-specific physiology during non-transplant surgery — and graft-first thinking passes where generic GA recipes fail.[1]
References5ShowHide
- [1]Herborn J, Parulkar S Anesthetic Considerations in Transplant Recipients for Nontransplant Surgery. Anesthesiol Clin, 2017.PMID 28784225
- [2]Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery. N Engl J Med, 2017.PMID 29130845
- [3]Gómez-Ramírez S, Bisbe E, Shander A, et al. Management of Perioperative Iron Deficiency Anemia. Acta Haematol, 2019.PMID 30970362
- [4]Steib A, Freys G, Otteni JC [Anesthesia for non-specific surgery in a post-transplantation patient]. Ann Fr Anesth Reanim, 1993.PMID 8338262
- [5]Kuypers DR Immunotherapy in elderly transplant recipients: a guide to clinically significant drug interactions. Drugs Aging, 2009.PMID 19728747