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Renal and liver transplantation are now recognized as therapeutic modalities for children with kidney and liver failure. This article reviews the general indications for transplantation, recipient selection, descriptions of the procedures, and the expected outcome of these two procedures in the pediatric setting.

Arterial hypoxemia may contribute to morbidity during cardiac catheterization. Therefore, we measured arterial hemoglobin oxygen saturation (SaO2) continuously using pulse oximetry in 29 patients (age range, 21 to 83 years) undergoing cardiac catheterization. Baseline SaO2was 96±0.4 percent. All patients had a decrease in SaO2at some time during the procedure. Eleven patients (38 percent) had episodes of arterial hypoxemia, defined as a decrease in SaO2below 90 percent. In these 11 patients, the mean number of episodes of hypoxemia was 16±7, and the mean duration of each episode was 53±25 seconds. Multiple stepwise regression analysis showed that the minimum SaO2during catheterization for any patient was significantly associated with the baseline SaO2, duration of the procedure, and end-diastolic volume (EDV) as described by the following regression equation: minimum SaO2= 46.8 –; 0.0580 (duration of procedure in minutes) + 0.5362 (baseline SaO2) −0.0159 (EDV). Based on our finding of arterial hypoxemia in greater than one third of our patients, we would consider continuous SaO2monitoring or supplemental oxygen during cardiac catheterization, especially for those patients with poor ventricular function or low resting SaO2or those expected to have long procedures.

The use of cardiopulmonary bypass, deep hypothermia and circulatory arrest has decreased the risks of hemorrhage, tumor embolization, incomplete thrombus resection, and warm hepatic and renal ischemia associated with resection of renal cell carcinoma extending into the inferior vena cava above the hepatic veins. Patients about to undergo this operation frequently have significant coronary artery and carotid artery disease, and are at risk for perioperative myocardial infarction and stroke. Preoperative evaluation of the coronary artery and carotid artery circulation by coronary angiography, duplex carotid artery scan and digital subtraction carotid angiography is recommended. Depending upon the severity and location of the cardiovascular disease a sequential or simultaneous operation may be performed. This surgical approach can be used in selected patients to facilitate complete tumor thrombectomy with a low operative risk.

The authors use data gathered from recent clinical and laboratory studies to deal with the following six questions often facing the physician caring for hypertensive patients before, during, and after surgery. Which hypertensive patient is at increased surgical risk? When must elective surgery be delayed? Should antihypertensive medication be discontinued preoperatively? What is the ideal intraoperative blood pressure? What anesthetic techniques are best suited for hypertensive patients? Which patients are at most risk of a postoperative hypertensive crisis?