2024-Perioperative Considerations in Older Kidney and Liver Transplant Recipients

Abstract. With the growth of the older adult population, the number of older adults waitlisted for and undergoing kidney
and liver transplantation has increased. Transplantation is an important and definitive treatment for this population. We present
a contemporary review of the unique preoperative, intraoperative, and postoperative issues that patients older than 65
y face when they undergo kidney or liver transplantation. We focus on geriatric syndromes that are common in older patients
listed for kidney or liver transplantation including frailty, sarcopenia, and cognitive dysfunction; discuss important considerations
for older transplant recipients, which may impact preoperative risk stratification; and describe unique challenges in
intraoperative and postoperative management for older patients. Intraoperative challenges in the older adult include using
evidence-based best anesthetic practices, maintaining adequate perfusion pressure, and using minimally invasive surgical
techniques. Postoperative concerns include controlling acute postoperative pain; preventing cardiovascular complications
and delirium; optimizing immunosuppression; preventing perioperative kidney injury; and avoiding nephrotoxicity and rehabilitation.
Future studies are needed throughout the perioperative period to identify interventions that will improve patients’
preoperative physiologic status, prevent postoperative medical complications, and improve medical and patient-centered
outcomes in this vulnerable patient population.
(Transplantation 2024;108: e346–e356).