Renal Autotransplantation and its Anesthetic Management: A Case Series in a Tertiary Hospital

Introduction: Renal autotransplantation (RAT) is an unusual but safe procedure that implies a combination of living nephrectomy and a standard renal transplantation in the same patient. Indications for surgery include treatment of vascular and urologic lesions, and less frequently nephrolithiasis or chronic flank pain. Objectives: Due to rarity of the procedure there are a few reports published and little is known about anesthetic management of these patients. The goal of this study is to describe all cases of renal autotransplantation, focusing on anesthetic management. Methods: A retrospective review of the records of all patients who underwent renal auto transplantation from 2002 to 2015 in Centro Hospitalar do Porto was performed. Demographic, anesthetic, surgical and postoperative data were collected. Results: A total of twenty-four patients underwent renal autotransplantation from 2002 to 2015, including two patients who underwent bilateral RAT. The most frequent indication for RAT was the presence of renal artery aneurysms and most patients underwent laparoscopic nephrectomy. High-grade complications according to ClavienDindo classification occurred in 16% of patients. Hypertension was the most frequent comorbidity among patients. Combined anesthetic techniques were used in 52% of cases. Median duration of anesthesia was 423 min. There were no anesthetic complications, apart from one patient with hypothermia at the end of the procedure. Conclusions: RAT is a reasonable option for selected patients. Others studies are needed in order to provide evidence if anesthetic management influences outcomes.