Issues relating to the renal allograft recipient undergoing non-transplant surgery
- Ron Shapiro, MD
Ron Shapiro, MD
- Professor of Surgery
- Surgical Director, Kidney/Pancreas Transplant Program
- Mount Sinai Hospital - Recanati Miller Transplantation Institute
- Section Editor
- 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
As both the short- and long-term outcomes after solid organ transplantation continue to improve, an increasing number of recipients require medical care not specifically related to their transplanted organ. Some require elective or emergency surgery.
Many of the principles of peri- and intraoperative management are the same in transplant and non-transplant patients. However, there are a few important differences. It is strongly recommended that the transplant center be consulted prior to any planned surgical intervention in kidney transplant recipients.
Some of the general issues concerning non-transplant surgery in the transplant patient will be discussed here, as well as a few specific surgical problems. General discussions of the pre- and perioperative medical management of patients are presented separately.
The clinician must integrate information from the history, physical examination, and laboratory tests to develop an initial estimate of perioperative risk. One major issue is the possible presence of significant coronary artery disease among those undergoing noncardiac surgery, a common finding among renal transplant recipients. (See "Risk factors for cardiovascular disease in the renal transplant recipient".)
A number of clinical and surgical determinants have been identified that allow cardiac risk stratification. The evaluation of patients with known or suspected cardiac disease prior to noncardiac surgery requires an appraisal of the patient's clinical risk profile in the context of the surgery to be performed and the attendant risks. Discussions of such an evaluation, as well as the general preoperative evaluation of patients, are presented separately. (See "Preoperative medical evaluation of the adult healthy patient" and "Evaluation of cardiac risk prior to noncardiac surgery" and "Evaluation of the potential renal transplant recipient".)
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