The preoperative evaluation of the transplanted patient for nontransplant surgery.

With the improved success of solid-organ transplantation, there has been an increased willingness to transplant individuals previously felt to be unsuitable for such procedures. Factors such as age and various medical comorbidities are no longer considered contraindications to transplantation, and hence, an increasing number of recipients may require medical care not specifically related to the transplant. After transplantation, many of these patients may require elective or emergent surgery, making it important for all surgeons to be familiar with the factors that may influence surgical outcomes in this population, asa well asa factors that affect postoperative care. Most transplant centres use a team approach to manage these complex patients, relying on medical professionals experienced in their care and management. Close interaction with the transplant team is likely the single most important step in preparing the transplanted patient for surgery and managing their postoperative care.

Pulse wave analysis to assess vascular compliance changes in stable renal transplant recipients.

BACKGROUND: Calcineurin inhibitor drugs (cyclosporine and tacrolimus) given to renal transplant recipients to prevent rejection are associated with an increased incidence of hypertension. Reduced arterial compliance, which is a consequence of hypertension, is associated with an increased risk of cardiovascular disease and can be measured noninvasively using pulse wave analysis technology. The purpose of the study was to determine whether calcineurin inhibitor drugs have any effect on arterial compliance. METHODS: A total of 36 stable renal transplant recipients were evaluated using pulse wave analysis to determine large and small vessel compliance. Of the patients, 18 were receiving cyclosporine and 18 tacrolimus. Patients were matched for age and sex. RESULTS: No significant differences in systolic blood pressure, diastolic blood pressure, heart rate, or small vessel compliance were observed. There was a significant decrease in large vessel compliance in patients receiving tacrolimus versus those receiving cyclosporine, respectively (13.5 +/- 4.0 mL/mm Hg x 10 v 9.9 +/- 3.3 mL/mm Hg x 10; P =.005). CONCLUSIONS: Differences in large vessel compliance in renal transplant subjects may depend on the choice of calcineurin inhibitor. Specifically, decreased large vessel compliance in tacrolimus-treated subjects may be associated with an increased cardiovascular risk. This may be due to a difference in vascular collagen accumulation or to elastin loss in large elastic arteries.