Perioperative Anesthesia Practices in Pediatric Kidney Transplantation Across Lower-Middle Income Countries (LMICs)...

Tertiary care centres offering pediatric kidney transplantation in Asia remain limited in numbers and peri-operative practices are often guided by individual experiences rather than robust evidence. Scientific analysis and sharing of these experiences across centres can help improve outcomes and guide healthcare authorities to develop context-specific, evidence-informed guidelines in limited resource settings.

A cross-sectional, anonymous electronic survey was conducted via Google Forms (January-December 2025) across pediatric kidney transplant centres in South Asian lower-middle income countries (LMICs) to capture peri-operative practices. Descriptive statistics were used for analysis.

A total of 22 responses were analyzed; respondents being physicians involved in pediatric kidney transplantation. The most frequently reported invasive monitoring was central venous pressure (90%) and arterial blood pressure (86%). High-volume centres (HVC- performing > 10 pediatric kidney transplants per year; n = 4) reported postoperative ICU stay of less than 24 h (p = 0.045), acceptable preoperative hemoglobin levels above 8 g/dL, target CVP of 10-12 mmHg and use of regional analgesia (p > 0.05). Eleven centres (including 50% HVC) reported using stroke volume variation or pulse pressure variation (SVV/PPV) to guide peri-operative fluid management. HVC managing younger (< 5 years) recipients (n = 4) reported CVP targets above 12 mmHg and donor-specific blood pressure goals during reperfusion.

This survey highlights lack of agreement between evidence and practices regarding the use of advanced invasive monitoring (SVV/PPV), reperfusion targets, analgesic approaches and duration of postoperative ICU stay.