Chapter 31 - Peri-operative care and early complications

Summary

This chapter describes the management of the renal transplant recipient from the time of their admission to hospital to discharge, including immediate preoperative preparation, postoperative management and early post-transplant complications. The presence or absence of primary function in the early postoperative phase is very important. Primary function is expected in all living donor transplants and most deceased donor procedures, particularly if the donor was donation after brain death (DBD) with a short cold ischemic time. Most patients will be managed with patient-controlled analgesia (PCA), with intravenous morphine or fentanyl. Ureteric obstruction is usually a late complication following renal transplantation and can be largely avoided in the early postoperative phase by the routine use of a ureteric stent. Patients present with acute graft dysfunction, with increasing serum creatinine and oliguria. Monitoring of levels is essential to ensure adequate drug exposure while minimizing exposure to toxic side effects such as nephrotoxicity.