Anaesthetic Management of Simultaneous Pancreas and Kidney Transplant Surgery: A Case Report

Abstract

End-stage renal disease is commonly attributed to chronic conditions such as Diabetes Mellitus (DM), a primary factor in the development of nephropathy. As awareness of organ donation grows, the availability of transplantable organs has also increased. Multiorgan transplants, such as Simultaneous Pancreas and Kidney (SPK) transplants, have become viable options, though very few cases have been reported, especially in India. The SPK transplant offers freedom from renal replacement therapy and dependence on insulin, drastically improving the quality of life for the patient. This case report discusses a 31-year-old male who was a known case of type I DM and had been on haemodialysis for end-stage renal failure for seven years. He was posted for an SPK transplant. A multidisciplinary approach was adopted, beginning in the preoperative period with the preparation of the patient through haemodialysis, immunosuppression, and optimisation of other co-morbidities. During the intraoperative period, the focus was done on focused on maintaining sufficient tissue perfusion without maximising cardiac filling and managing fluctuations in blood glucose levels and electrolyte abnormalities. In the postoperative period, vigilance and utmost care were prioritised to ensure successful management of this SPK transplant. Given the benefits that SPK transplants can provide to patients, it is likely that this will become the treatment modality of choice for these long-term debilitating conditions. Therefore, in addition to understanding appropriate anaesthesia management for such cases, the importance of good team coordination should be emphasised to enhance graft survival and function, with the ultimate aim of improving the quality of life for transplant recipients.

Keywords

• end stage renal disease
• haemodialysis
• insulin dependence
• transplant anaesthesia
• type 1 diabetes mellitus