Early postoperative renal function following renal transplantation surgery: effect of anesthetic technique

The use of continuous epidural anesthesia in patients with chronic renal failure is rare and controversial. In this study, we compared the effects of epidural versus general anesthesia on early postoperative renal function in patients who underwent renal transplantation surgery.

Sixty-eight adult patients were prospectively randomized to two groups. Group 1 (n-37) received epidural anesthesia with bupivacaine and fentanyl, and group 2 (n-31) received general anesthesia with nitrous oxide and isoflurane. The patients' renal function was compared both with qualitative scintigraphic analysis (kidney perfusion, concentration, and excretion capabilities) and biochemically [serum sodium, potassium, creatinine, and blood urea nitrogen) (BUN)] within the first postoperative week.

Patient demographics were similar in the two groups, and the scintigraphic and biochemical evaluations were also comparable. The time of the first appearance of Tc-99m diethylene triamine pentaacetic acid (DTPA) was within normal limits in 75.7% of patients in group 1 and 61.3% of those in group 2. The number of patients with normal peak/background activity and 20 min/peak activity were 15 (40.5%) and 19 (51.4%), respectively, in group 1, and 12 (38.7%) and 15 (48.4%) in group 2 (P > 0.05 for both). The levels of serum creatinine and urea in both groups decreased within days postsurgery compared with preoperative levels (P < 0.05), but the changes were similar in the two groups (P > 0.05). A similar number of patients in both groups were treated for acute rejection (P > 0.05).

Our results demonstrate the safe use of both anesthetic techniques in renal transplantation surgery.