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If warranted, a preop CBC may be done to document the platelet count. Anemia currently better treated with erythropoietin. Turnaround time is quickest with a STAT venous blood gas-make sure that the panel you order includes electrolytes!

Electrolytes- Depending on dialysis history and recent lab values, you may wish to check K+ and HCO3- before surgery.

Common to bolus 4 units and infuse 4 units/hr, but modify based on patient’s preoperative insulin regimen.

Diabetes- Check serum glucose, start insulin infusion once glucose greater than 150-180 mg/dl.

Discuss with your attending the utility of vasopressin to treat hypotension if your patient is on an ACEI/ARB. Because the timing of a deceased donor kidney is unpredictable, these patients are more likely to have already taken these meds. The Prepare clinic generally tells other surgical patients to not take these drugs due to concern for refractory hypotension on induction.

ACEIs & ARBs- Check to see if your patient has taken one of these.

Intra-operative goal is to keep patient at or slightly above baseline, but this goal may need modification if the patient’s baseline borders on hypertensive urgency, or on the low end of normotension. Know the patient’s anti-hypertensive regimen, what medications they took on DOS, and where their BP usually runs.

Hypertension- Common in the ESRD population.

Cardiovascular Risk- Coronary artery disease: Stress test, Echo with global EF, PA systolic pressure, Coronary Angiogram? Pacemaker? When depressed EF is secondary to uremia, cardiac function usually recovers after transplantation.

Sometimes important data can be found in “Care Everywhere” or “Letters.” Sometimes the information is hard to find. System is set up so that candidates have a review and reevaluation approximately 1 year before anticipated transplant. walk- in appointment with Prepare clinic.Ģ) State of Dialysis- Should be reviewed: last dialysis, type of dialysis, serum potassium, bicarbonate, and dry weight prior to OR.ģ) Associated co-morbidities- Should already have an extensive work-up as above.

Glomerular disease (FSGS, IgA nephropathy, SLE, etc)ġ) Living Donor Recipients- Typically pre-screened by Dr Claus Niemann for phone consult vs.Most common causes of ESRD requiring kidney transplant: Wait list times are higher than national averages.~5,400 people on the kidney transplant waiting list at UCSF.2013- 345 kidney transplants (211 deceased donor allografts and 134 live donor allografts).Busiest kidney transplant center in California.101,000 patients on the waiting list as of January 2015.Additional rules for pediatrics, blood type B, and patients who are immunologically hard to matchĦ) Recipients from living donors: often are earlier in their disease process may be on peritoneal dialysis or never have been dialyzed (preemptive transplantation).have a high chance of surviving with a transplanted kidney for a longer time.with a high chance of lasting a longer time (as determined by donor factors) with recipients who.The allocation system now tries to match kidneys Likelihood of long-term need for a kidney.Time on dialysis (now receive credit for any time spent on dialysis prior to being listed).Elements that determine a patient’s likelihood of receiving an offer include: Additional consultants (Hematology, Pulmonary, Infectious Disease, Rheumatology, Immunologic, Dental, etc.) as needed for comorbidities.ģ) Immunologic evaluation- ABO blood group determination, human leukocyte antigen (HLA) typing, screening for antibodies to HLA phenotypes, and cross-matching.Ĥ) Additional Health Maintenance: Per established guidelines for example, age-appropriate colon cancer screening in patients older than 50.ĥ) Allocation- The allocation system for kidneys was revised at the end of 2014. How a patient gets on the UCSF Transplant listġ) Evaluation- Transplant nephrologists, Transplant surgeon, social worker, financial counselor begin the evaluationĢ) T esting- Given high prevalence of diabetes and hypertension in the ESRD population, most patients will have an ECG, echo, and possibly a stress test in the system. UCSF Anesthesia Resident Pearls: Renal Transplant