• Beatriz Tena and Marina Vendrell.
• Anesthesiology Department, Hospital Clinic Barcelona, c/ Villarroel 170, 08036, Barcelona, Spain. Electronic address: btena@clinic.cat.
• Best Pract Res Clin Anaesthesiol. 2020 Mar 1; 34 (1): 3-14.

AbstractKidney transplantation is the treatment of choice in patients with end-stage renal disease, as it improves survival and quality of life. Living donor kidney transplant prior to pancreas transplantation, or simultaneous pancreas and kidney transplantation are discussed. Patients usually present comorbidities and extensive preoperative workups are recommended, especially cardiac assessment, though type and frequency of surveillance is not established. Nephroprotective strategies include adequate fluid status and goal-directed therapy. The conventional use of diuretics has not demonstrated a real nephroprotective effect at follow-up. Thromboprophylaxis regimes, especially for the pancreatic graft outcome, are of importance. Notably, transplantation in the obese population has increased in recent decades. Strict preoperative evaluation and pulmonary considerations must be kept in mind. Finally, robotic kidney transplant is a recent approach that presents anesthetic challenges, mainly related to steep Trendelenburg position and fluid restriction.Copyright © 2020 Elsevier Ltd. All rights reserved.

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