Combined spinal-epidural anesthesia for renal transplant in a lung transplant recipient: a case report

Combined spinal-epidural anesthesia for renal transplant in a lung transplant recipient: a case report


  • Valentina Bellini
  • Cristiana Madoni
  • Marco Badino a:1:{s:5:"en_US";s:19:"University of Parma";}
  • Paolo Del Rio
  • Maurizio Iaria
  • Carmelo Puliatti
  • Elena Bignami


Renal Transplant, Combined Spinal-Epidural Anesthesia, lung transplant, perioperative medicine


A 67-year-old lung transplant recipient with severe comorbidities was admitted for renal transplant. As anesthesia technique, combined spinal-epidural at the T11-T12 level was chosen, associated with intravenous sedation. Graft’s function initially results altered, bringing to pulmonary fluid overload. Beginning from the postoperative day 5 there was a slow but constant gain-of-function of the graft, proven by an improvement of renal function indexes and by the resolution of the pulmonary edema.

Conclusions: Whereas general anesthesia remains the gold standard anesthesia technique for kidney transplant, a locoregional anesthesia, could be a feasible and effective option in patients at high risk of respiratory complications. (


Seo M, Kim WJ, Choi IC. Anesthesia for non-pulmonary surgical intervention following lung transplantation: two cases report. Korean J Anesthesiol. 2014 Apr;66(4):322-6. doi: 10.4097/kjae.2014.66.4.322.

Feltracco P, Falasco G, Barbieri S, Milevoj M, Serra E, Ori C. Anesthetic considerations for nontransplant procedures in lung transplant patients. J Clin Anesth. 2011;23(6):508-516. doi: 10.1016/j.jclinane.2011.05.002.

Royer PJ, Olivera-Botello G, Koutsokera A, et al. Chronic Lung Allograft Dysfunction: A Systematic Review of Mechanisms. Transplantation. 2016 Sep; 100(9):1803-1814. doi: 10.1097/TP.0000000000001215.

Massoudi N, Safari F, Mottaghi K. Spinal Anesthesia for Renal Transplantation in Lung Resected Patient: A Case Report. Tanaffos. 2018, Mar; 17(3):207-210.

Ricaurte L, Vargas J, Lozano E, Díaz L; Organ Transplant Group. Anesthesia and kidney transplantation. Transplant Proc. 2013 May;45(4):1386-91. doi: 10.1016/j.transproceed.2012.12.014.

Bhosale G, Shah V. Combined Spinal-Epidural Anesthesia for Renal Transplantation. Transplant Proc. 2008; 40(4):1122-1124. doi: 10.1016/j.transproceed.2008.03.027.

Hadimioglu N, Ertug Z, Bigat Z, Yilmaz M, Yegin A. A randomized study comparing combined spinal epidural or general anesthesia for renal transplant surgery. Transplant Proc. 2005 Jun;37(5):2020-2. doi: 10.1016/j.transproceed.2005.03.034.

Clemente A, Carli F. The physiological effects of thoracic epidural anesthesia and analgesia on the cardiovascular, respiratory and gastrointestinal systems. Minerva Anestesiol. 2008;74(10):549-563.

Amir-Zargar MA, Gholyaf M, Kashkouli AI, Moradi A, Torabian S. Comparison of safety and efficacy of general and spinal anesthesia in kidney transplantation: Evaluation of the peri-operative outcome. Saudi J Kidney Dis Transpl. 2015;26(3):447-452. doi: 10.4103/1319-2442.157300.

Ferré F, Martin C, Bosch L, Kurrek M, Lairez O, Minville V. Control of Spinal Anesthesia-Induced Hypotension in Adults. Local Reg Anesth. 2020 Jun 3;13:39-46. doi: 10.2147/LRA.S240753.

Wuethrich PY, Burkhard FC, Thalmann GN, Stueber F, Studer UE. Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial. Anesthesiology. 2014 Feb;120(2):365-77. doi: 10.1097/ALN.0b013e3182a44440.

Lemmens HJM. Anesthesia for kidney transplantation. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. Accessed 4, 2021.

Sanghani NS, Soundararajan R, Golper TA. Medical management of the dialysis patient undergoing surgery. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. Accessed 4, 2021.

Monsalve C, Izquierdo L, Alcaraz A. Interactions Between Hemodynamics and Pharmacology in Kidney Transplantation. Transplant Proc. 2011; 43(1):359-362. doi: 10.1016/j.transproceed.2010.12.018.

Ma GG, Tu GW, Zheng JL, et al. Changes in Stroke Volume Variation Induced by Passive Leg Raising to Predict Fluid Responsiveness in Cardiac Surgical Patients With Protective Ventilation. J Cardiothorac Vasc Anesth. 2020;34(6):1526-1533. doi: 10.1053/j.jvca.2019.10.002.






Case Reports: General Surgery and Miscellanea

How to Cite

Bellini V, Madoni C, Badino M, Del Rio P, Iaria M, Puliatti C, et al. Combined spinal-epidural anesthesia for renal transplant in a lung transplant recipient: a case report. Acta Biomed [Internet]. 2022 May 25 [cited 2024 Jul. 19];93(S1):e2022205. Available from: