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The New Kidney Donor Allocation System and Implications for Anesthesiologists.
Srikanth Sridhar1, Sara Guzman-Reyes1, Sam D Gumbert1
11 UTHealth McGovern Medical School, Houston, TX, USA.
Seminars in Cardiothoracic and Vascular Anesthesia
|September 5, 2017
Summary
The new kidney allocation system improves deceased donor kidney transplants. Anesthesiologists face challenges managing complex patients with end-stage renal disease, requiring specialized care considerations.
Area of Science:
- Nephrology
- Transplantation Medicine
- Anesthesiology
Background:
- The 2014 federal kidney allocation system aimed to address disparities in deceased donor kidney transplantation.
- End-stage renal disease (ESRD) and prolonged dialysis present significant perioperative challenges for kidney transplant recipients.
Purpose of the Study:
- To describe the kidney allocation system and its early outcomes.
- To review implications for anesthesiologists managing kidney transplant recipients under the new system.
Main Methods:
- Review of the kidney allocation system implemented in 2014.
- Analysis of early data regarding system goals.
- Summary of organ system considerations relevant to anesthesiology.
Main Results:
- Early analyses indicate the kidney allocation system is achieving many of its intended goals.
- Increased dialysis duration and ESRD burden contribute to cardiopulmonary disease and complex fluid/hemodynamic management.
Conclusions:
- Anesthesiologists require updated guidance for perioperative care of kidney transplant recipients under the new system.
- Consideration should be given to dedicated anesthesiology teams for complex transplant patients, similar to liver transplant protocols.
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