Perioperative management of a bilateral forearm allograft

Composite tissue allotransplantation (CTA) is a complex procedure requiring a multidisciplinary collaboration between surgeons, anesthetists, and transplantation specialists. We will describe the perioperative management of a bilateral forearm allograft performed at our facility. A 40-year-old man who lost both forearms was registered on the transplant waiting list; a suitable graft was available 11months later. Anesthesia required planning for vascular access, hemodynamic monitoring, fluid therapy management and prevention of deep vein thrombosis. Blood loss was not quantifiable, which made coagulation management challenging. Reperfusion syndrome required the use of vasopressors. Postoperatively, moderate rhabdomyolysis without acute renal failure was observed. No complications such as thrombosis, hemorrhage, or opportunistic infections occurred during the early postoperative period. A comprehensive, protocol-driven, patient care strategy is crucial for the proper conduct of the surgical procedure and graft survival.