Enflurane in renal transplantation: report of 375 cases

Our experience to date covers 675 kidney grafts performed in the Transplantation Department of the University of Louvain. The evolution of our anaesthesia methods has led us since the end of 1973 to conduct 375 transplantations with enflurane. The patients, aged between 18 months and 50 years, receive a conventional premedication, do not receive corticoids preoperatively nor undergo dialysis immediately prior to operation, but systematically receive a 5-unit transfusion beforehand. Having successively abandoned gallamine, succinylcholine, thiopentone and finally halothane, our present anaesthetic protocol is as follows: induction under benzodiazepines, fentanyl and enflurane, intubation under laryngeal anaesthesia. Maintenance: enflurane (2--3 MAC hours) in open circuit, pancuronium (0.02 mg/kg/h) and occasionally fentanyl. Details and comparative advantages are discussed. This anaesthesia technique combined with the systematic administration of antilymphocytic and antithymocytic serum in the postoperative period, and particularly the preliminary transfusion (producing blocking antibodies), has provided us, using cadaver kidney, with a survival rate of 96% at 6 months, 86% at 1 year and 80% at 2 years, the longest presently being 15 years.