March 2017

A patient is to receive a cadaveric renal transplant.
a) Detail the aspects of your pre-operative assessment specific to chronic kidney disease (CKD).
(11 marks)
b) How can the function of the transplanted kidney be optimised intraoperatively? (3 marks)
c) How may this patient’s postoperative pain be optimally managed? (3 marks)
d) Explain why some common post-operative analgesic drugs should be avoided or used with caution.
(3 marks)
Pass rate 42.1%
Renal transplantation is the most frequently undertaken form of transplant surgery but it seemed that many candidates had not had any practical experience of it. This was particularly noticeable in the answers to part b, improving the function of the transplanted kidney intraoperatively, and part c, management of postoperative pain. However, even candidates who have never seen a renal transplant operation should know the principles of analgesic use in renal failure.
September 2014

A patient is to receive a cadaveric renal transplant.
  • a)  Detail the aspects of your pre-operative assessment specific to chronic kidney disease (CKD).
    (11 marks)
  • b)  How can the function of the transplanted kidney be optimised intraoperatively? (3 marks)
  • c)  How may this patient’s postoperative pain be optimally managed? (3 marks)
  • d)  Explain why some common post-operative analgesic drugs should be avoided. (3 marks)


Pass Rate 59.1%
Overall this question was answered well and was a very strong discriminator between candidates. Weaker candidates tended to ignore the anaesthetic implications of; 1) diseases which lead to chronic renal failure, 2) the importance of preserving dialysis catheters / fistulae sites, 3) the implications of a prior failed renal transplantation and any associated immunosuppressive therapy, and most surprisingly 4) the need for pre- operative investigations. Inexperience is the most likely cause of these omissions.
March 2013

A 56-year-old man is listed for elective surgery. He received an orthotopic heart transplant 12 years before.

a) What key alterations in cardiac physiology and function must be considered when planning general anaesthesia? (50%)

b) What are the implications of the patient’s immunosuppressant therapy for perioperative care? (30%)

c) What long-term health issues may occur in this type of patient? (20%)
27% pass rate.

It is not uncommon to have a patient presenting for surgery that has received a transplanted organ and is on immunosuppressive therapy. A similar question was asked in October 2001. This question proved to be the most difficult question on the paper. A majority of the candidates demonstrated poor understanding of the physiology of a transplanted heart and the side effects of immunosuppressive therapy of relevance to the anaesthetist.
Increased infection risk – may need antibiotic prophylaxis/ strict asepis Common agents cause a degree of chronic kidney disease
Avoid NSAIDs – enhanced side effects
Important to maintain stable plasma levels – ensure drugs taken / given IV steroid cover may be required
Cyclosporine enhances and azothioprine reduces aminosteroid NMB action