Anesthetic management of laparoscopic dual renal transplantation

Since the first laparoscopic nephrectomy was reported in 1991, this technique has evolved rapidly and laparoscopic donor nephrectomy has emerged as a standard of care in many institutions. However, recipient renal transplantation is still performed by the traditional open approach. There is only one case report of laparoscopic kidney transplantation (LKT) from Spain in 2009. LKT is a technically demanding surgery for a urologist and equally challenging for an anesthesiologist as he has to be vigilant because of the major perturbations in the cardiorespiratory system due to steep trendelenberg position and pneumoperitoneum; additionally, the pneumoperitoneum can have deleterious effects on blood flow and function of the transplanted kidney. We herewith present our experience with anesthesia of the first laparoscopic dual kidney transplantation from a deceased donor performed in our center.