Successful Kidney Transplantation Under Combined Spinal-Epidural Anesthesia in a Patient With a History of Left Pneumonectomy Due to Bronchiectasis.
Merve Aktar, Adem Tunçer, Selda Karagöz et al.
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Case in brief
A 33-year-old man with end-stage kidney disease from biopsy-proven AA amyloidosis was assessed for preemptive living-donor kidney transplantation. He had previously undergone left pneumonectomy for bronchiectasis and had severe mixed restrictive-obstructive impairment, with additional bronchiectatic changes in the remaining lung. Because general anesthesia was considered high risk, the transplant from his HLA-identical sister was performed under combined spinal-epidural anesthesia. There was no intraoperative respiratory or hemodynamic instability. Serum creatinine fell from 6.6 mg/dL before surgery to 0.63 mg/dL on postoperative day 3, and heavy proteinuria improved during follow-up.
What made this case unusual
The transplant was completed under combined spinal-epidural anesthesia despite severe pulmonary impairment after pneumonectomy, avoiding the anticipated risks of general anesthesia.
Diagnostic / clinical pearl
In a carefully selected transplant candidate with markedly reduced respiratory reserve after pneumonectomy, individualized anesthetic planning may allow kidney transplantation under combined spinal-epidural anesthesia.
Why it matters
The case underscores the value of close multidisciplinary coordination when assessing transplant feasibility in patients with major pulmonary comorbidity.