Introduction: Kidney transplant recipients have several co-morbidities which further complicates the surgical procedure and peri-operative recovery. Therefore, extensive pre-operative evaluation is performed on end-stage renal disease patients to assess their physical fitness for kidney transplant. Close hemodynamic monitoring during kidney transplant is performed to avoid intra- and post-operative complications. We aimed to review our clinical experience in managing kidney transplant recipients and evaluated their immediate post-operative outcomes. We aim to assess which patients can potentially avoid intensive care (ICU) management following kidney transplant.

Methods: A consecutive series of 100 patients who underwent kidney transplantation were reviewed. All demographic data including patient age, body mass index (BMI), and American Society of Anesthesiologists (ASA) scores were collected. Co-morbidities were reviewed on all patients. All patient’s post-operative course was evaluated. All patients who were admitted to intensive care units were reviewed. Patients were divided into two groups for comparison, Group A (ICU care) and Group B (standard surgical floor care).

Results: 54 patients required intensive care admission (Group A). The mean age of patients was 54 years and BMI was 30.1 (Group A). There were 38 (70%) male and 16 (30%) female patients who required ICU care after kidney transplant. ASA score was III for 41 (76%) and IV for 13 (24%) of Group A patients. The indications for ICU admission were hypertensive urgency [n=31 (57%)], hypotension [n=12 (22%)], respiratory failure [n=3 (5%)], diabetic ketoacidosis [n=3 (5%)], hemodynamic monitoring [n=3 (5%)], hyperkalemia [n=1 (2%)], and arrhythmia [n=1 (2%)]. The mean SICU stay was 2.1 (range 1-6) days. All 54 patients required insertion of an arterial line for hemodynamic monitoring.

Conclusions: A routine critical care admission is not required after kidney transplant. The majority of patients who required admission for ICU care were for management of post-operative hypertension. Optimal peri-operative hypertension management can help to avoid potential intensive care requirements. This can avoid excessive cost and lead to better utilization of intensive care resources.