الفهرس 
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Abstract
Summary
Renal transplantation is the preferred treatment for end
stage renal disease. Renal transplant anesthesia requires a
thorough understanding of the metabolic and systemic
abnormalities in end stage renal disease, familiarity with
transplant medicine and expertise in managing and optimizing
these patients for the best possible outcome.
End stage renal disease is a multisystem disease that affects
many systems in the body including the cardiovascular,
respiratory, central nervous system, and the gastrointestinal tract.
It also disturbs the fluid and electrolyte balance in the body.
Kidney can be obtained from living donors, donors after
brain or cardiac death. Transplantation from living healthy
compatible donors carries the best prognosis.
Problems encountered by anesthetists in renal transplant
recipients include hypertension, ischemic heart disease,
congestive heart failure, anemia, metabolic acidosis,
hyperkalemia, hyponatremia and circulatory collapse. Although
solutions to most of these have been found over the past 50 years,
the renal transplant procedure still carries significant risk of peri
and postoperative complications (mostly cardiovascular) and even
fatal outcome.
Summary
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General anesthesia is the choice technique for renal
transplantation, but several studies have shown that regional
anesthesia can be used successfully and gives better postoperative
analgesia. Kidney transplantation is a highrisk surgery; anesthetic
and surgical techniques used should be carefully evaluated.
Intraoperative optimisation of blood volume and
maintenance of adequate blood pressure holds the key in early
success of transplanted kidney and thus an anesthesiologist plays
a pivotal role in complete success of the surgery.
Immunosuppressive therapy is a key component for
successful kidney transplantation. It is commonly believed that
more intensive immunosuppression is needed initially to prevent
rejection episodes and less immunosuppression is subsequently
maintained to minimize the overall risk of infection and
malignancy. The selection of drugs should be guided by a
comprehensive assessment of the immunologic risk, patient
comorbidities, financial cost, drug efficacy and adverse effects.