Perioperative Care of Kidney Transplant Recipients: A Cross-Sectional Canadian Multidisciplinary Survey

The perioperative period is a critical phase for kidney transplantation. Emerging evidence indicates the potential utility of several perioperative strategies to support immediate graft function and patient outcomes. In other countries surveying only anesthesiologists, there is broad variation in the reported routine care for kidney transplant recipients.

We sought to describe routine perioperative care for kidney transplant from a multidisciplinary perspective including perioperative clinicians (nephrologists, surgeons and anesthesiologists) caring for kidney transplant recipients in Canada.

We created an evidence-informed qualitative and quantitative survey of routine perioperative practices using an iterative and collaborative process. The survey was reviewed by our multidisciplinary group and tested by 3 nephrologists, 3 surgeons and 3 anesthesiologists prior to circulation.

After research ethics board approval, an online survey was distributed via e-mail to all Canadian adult kidney transplant centers. Transplant directors were asked by e-mail to distribute the survey to transplant nephrologists, surgeons and anesthesiologists involved in the perioperative care of kidney transplant recipients at their center. Survey responses were collected electronically from January 13, 2025 to April 13, 2025.

We recorded all answers to our survey questions including multiple choice and free-text responses.

We defined agreement as >70% of respondents selecting the same response for a routine perioperative care question. Descriptive statistics were used to describe the variation across disciplines and across transplant centers in Canada.

Respondents included 18 nephrologists, 14 surgeons and 39 anesthesiologists representing all kidney transplant centers in Canada (n=18). We found several areas of agreement including preoperative hemoglobin optimization and transfusion targets, hemodynamic monitoring, immunosuppression and use of preoperative dialysis. Routine care was variable with respect to the use of diuretics, blood pressure targets and intravascular fluid.

We were unable to link reported routine care practices with patient or graft outcomes. We also are unable to provide consensus recommendations for perioperative care based on this survey study.

We describe perioperative care for kidney transplantation by transplant nephrologists, surgeons and anesthesiologists in Canada. Some elements of care exhibit variation in practice while others show consistency between transplant clinicians and transplant hospitals. These findings identify priority areas of practice variation that may inform the design of future comparative studies and the development of evidence-informed perioperative strategies.