Perioperative Management for Patients with a Solid Organ Transplant

The need for surgery in the early or late posttransplant period is increasing in the solid organ transplanted population: between 15% and 40% of the solid organ transplant recipients will undergo invasive procedures:—as a consequence, these patients have to be assessed for every form of anesthesia (general, locoregional) or sedation (from moderate to deep sedation) to undergo elective and emergency non-transplant surgery, for interventional radiologic and endoscopic procedures (gastrointestinal, thoracic, or urologic) and for traumatic events. Aging of the recipients, the increasing number of comorbidities (particularly cardiopulmonary, metabolic, and gastrointestinal), and the occurrence of de novo cancer are creating a new, relevant form of chronic illness population every anesthesiologist can find in everyday clinical practice. We will review the anesthesiological and perioperative management of heart-, lung-, kidney-, and liver-transplanted patients, focusing on the peculiar aspects of the new posttransplant physiology introduced by the denervated graft, able to impact on the conduction of the surgical anesthesia and on the immediate postoperative period. Preoperative assessment and organ-specific anesthesiological issues will be reviewed.