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
- Washington University School of Medicine
- 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'.)
- Cheng EY, Leeser DB, Kapur S, Del Pizzo J. Outcomes of laparoscopic donor nephrectomy without intraoperative systemic heparinization. J Urol 2010; 183:2282.
- Ramani AP, Gill IS, Steinberg AP, et al. Impact of intraoperative heparin on laparoscopic donor nephrectomy. J Urol 2005; 174:226.
- Wilson CH, Sanni A, Rix DA, Soomro NA. Laparoscopic versus open nephrectomy for live kidney donors. Cochrane Database Syst Rev 2011; :CD006124.
- Lewis GR, Brook NR, Waller JR, et al. A comparison of traditional open, minimal-incision donor nephrectomy and laparoscopic donor nephrectomy. Transpl Int 2004; 17:589.
- Yang SL, Harkaway R, Badosa F, et al. Minimal incision living donor nephrectomy: improvement in patient outcome. Urology 2002; 59:673.
- Perry KT, Freedland SJ, Hu JC, et al. Quality of life, pain and return to normal activities following laparoscopic donor nephrectomy versus open mini-incision donor nephrectomy. J Urol 2003; 169:2018.
- Matas AJ, Bartlett ST, Leichtman AB, Delmonico FL. Morbidity and mortality after living kidney donation, 1999-2001: survey of United States transplant centers. Am J Transplant 2003; 3:830.
- El-Galley R, Hammontree L, Urban D, et al. Anesthesia for laparoscopic donor nephrectomy: is nitrous oxide contraindicated? J Urol 2007; 178:225.
- Redfors B, Bragadottir G, Sellgren J, et al. Effects of norepinephrine on renal perfusion, filtration and oxygenation in vasodilatory shock and acute kidney injury. Intensive Care Med 2011; 37:60.
- Albanèse J, Leone M, Garnier F, et al. Renal effects of norepinephrine in septic and nonseptic patients. Chest 2004; 126:534.
- Girish P. Joshi and Anthony Cunningham. Anesthesia for Laparoscopic and Robotic Surgeries. In: Clinical Anesthesia, Paul G. Barash. (Ed), Lippincott Williams Wilkins, Philadelphia 2013. Vol Seventh, p.1257-73.
- Hager H, Reddy D, Mandadi G, et al. Hypercapnia improves tissue oxygenation in morbidly obese surgical patients. Anesth Analg 2006; 103:677.
- Fleischmann E, Herbst F, Kugener A, et al. Mild hypercapnia increases subcutaneous and colonic oxygen tension in patients given 80% inspired oxygen during abdominal surgery. Anesthesiology 2006; 104:944.
- Meininger D, Byhahn C, Mierdl S, et al. Positive end-expiratory pressure improves arterial oxygenation during prolonged pneumoperitoneum. Acta Anaesthesiol Scand 2005; 49:778.
- O'Malley C, Cunningham AJ. Physiologic changes during laparoscopy. Anesthesiol Clin North America 2001; 19:1.
- Gutt CN, Oniu T, Mehrabi A, et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg 2004; 21:95.
- Sammour T, Mittal A, Loveday BP, et al. Systematic review of oxidative stress associated with pneumoperitoneum. Br J Surg 2009; 96:836.
- Feltracco P, Ori C. Anesthetic management of living transplantation. Minerva Anestesiol 2010; 76:525.
- Najarian JS, Chavers BM, McHugh LE, Matas AJ. 20 years or more of follow-up of living kidney donors. Lancet 1992; 340:807.
- Randolph H. Steadman and Christopher L. Wray. Anesthesia for Abdominal Organ Transplantation. In: Miller's Anesthesia, Eighth, Ronald D. Miller. (Ed), Elsevier, Philadelphia 2015. p.2262-91.
- Ashcraft EE, Baillie GM, Shafizadeh SF, et al. Further improvements in laparoscopic donor nephrectomy: decreased pain and accelerated recovery. Clin Transplant 2001; 15 Suppl 6:59.
- Waits SA, Hilliard P, Sheetz KH, et al. Building the case for enhanced recovery protocols in living kidney donors. Transplantation 2015; 99:405.
- 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