Anesthesia for living kidney donors
- Hendrikus J M Lemmens, MD, PhD
Hendrikus J M Lemmens, MD, PhD
- Professor of Anesthesia
- Stanford University School of Medicine
- Section Editors
- Michael Avidan, MD
Michael Avidan, MD
- Section Editor — Surgical Critical Care
- Professor of Anesthesiology and Surgery
- Washington University School of Medicine
- Daniel C Brennan, MD, FACP
Daniel C Brennan, MD, FACP
- Editor-in-Chief — Nephrology
- Section Editor — Renal Transplantation
- Professor of Medicine
- Medical Director and Co-Director of the Comprehensive Transplant Center, Department of Internal Medicine, Division of Nephrology
- Johns Hopkins Medical School
- Deputy Editors
- Nancy A Nussmeier, MD, FAHA
Nancy A Nussmeier, MD, FAHA
- Deputy Editor — Anesthesiology
- Department of Anesthesia, Critical Care, and Pain Medicine
- Massachusetts General Hospital
- Alice M Sheridan, MD
Alice M Sheridan, MD
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
Living kidney donors are in good health, with normal kidney function and without chronic illness or clinically significant hypertension. This topic will review anesthetic management of the living donor during nephrectomy, with emphasis on the primary considerations of safety and comfort.
The medical evaluation of a prospective living kidney donor and the risks of donor nephrectomy are reviewed separately. (See "Evaluation of the living kidney donor" and "Risk of living kidney donation".)
ADVANTAGES AND DISADVANTAGES OF LIVING DONOR KIDNEY TRANSPLANTATION
Kidneys from living donors have better graft and patient survival rates for the recipient than do kidneys from deceased donors. This is because living donors are physiologically and hemodynamically normal; hence, the graft is not exposed to ischemic alterations associated with brain death or cardiac death in deceased donors. Also, transplantation can be scheduled electively, with both donor and recipient surgeries coordinated at the same facility. This minimizes cold ischemia time for the donated kidney.
In ideal circumstances, kidney transplantation from a living donor is preemptive, so that the recipient with end-stage renal disease (ESRD) avoids the complications of dialysis altogether. (See "Evaluation of the potential renal transplant recipient", section on 'Timing of transplantation referral' and "Renal transplantation in diabetic nephropathy", section on 'Pre-emptive transplantation and living-donor versus deceased kidneys' and "Dialysis issues prior to and after renal transplantation", section on 'Preemptive transplantation'.)
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- ADVANTAGES AND DISADVANTAGES OF LIVING DONOR KIDNEY TRANSPLANTATION
- PREANESTHESIA CONSULTATION
- INTRAOPERATIVE MANAGEMENT
- Surgical techniques
- - General considerations
- - Laparoscopic versus open nephrectomy
- Anesthetic techniques
- - Vascular access
- - Induction and maintenance of general anesthesia
- - Protection of the donor kidney
- - Maintenance of hemodynamic stability
- - Laparoscopic nephrectomy: Specific anesthetic considerations
- Mechanical ventilation
- Cardiovascular function
- - Open nephrectomy: Specific anesthetic considerations
- POSTOPERATIVE COMPLICATIONS
- Cardiopulmonary complications
- Blood loss
- - Pain control after laparoscopy
- - Pain control after open nephrectomy
- Gastrointestinal complications
- SUMMARY AND RECOMMENDATIONS