2025 FSA Podium and Poster Abstracts

Introduction: Intraoperative hypotension during kidney transplantation can be multifactorial. Possible contributing factors to hypotension in patients with end stage renal disease  undergoing transplantation can  include hypovolemia, autonomic dysfunction, and drug reactions. We discuss a case of significant intra-operative hypotension that required the transplant procedure to be cancelled for the intended recipient.

Methods: We collected data on a 49 year old patient scheduled for deceased donor kidney transplant. Patient  underwent standard per-transplant evaluation. Patient has been hemodialysis dependent for last 9 years. Patient only known co-morbidity was hypertension. Only pre-operative investigations were normal on the day of surgery.

Results: After induction of anesthesia patient remained stable for 30 minutes. Then there was a sudden drop in patient blood pressure to 40 mm of Hg. All supportive measures were initiated. Patient was put into Trendelenburg position, placement of central line, initiation of pressors, 2 liters of IV bolus of fluid. After atleast five minutes of resuscitation  patients blood pressure marginally improved to 60 systolic. All surgical dissection was stopped while active patient resuscitation was continued. There was noticeable bleeding in the operative field. Immediate trans-esophageal echo was performed. No right or left heart stain was identified with EF of 50%. Patient’s condition improved after continuous resuscitation and was transferred to intensive care while intubated. Patient was extubated later that evening after significant hemodynamic stability. Patient was investigated both inpatient and outpatient and no single cause was identified.

Conclusion: Kidney transplant procedures can be complicated by sudden and unexpected intra-operative hemodynamic changes which cannot be predicted based on previous normal pre-transplant evaluation and investigations.