ANESTHETIC MANAGEMENT IN RENAL TRANSPLANTATION / UVA CLINICAL ANAESTHESIA 1 Advanced Anesthetic Strategies for Improving Renal Transplantation Success Indunil Karunarathna 1 , Sau Bandara 1 , Asoka Jayawardana 1 , Kapila De Alvis 1 , P Gunasena 1 , T Hapuarachchi 1 , U Ekanayake 1 , S Rajapaksha 1 , K Gunawardana 1 , P Aluthge 1 , S Gunathilake 1 1. Ministry of Health / Teaching Hospital Badulla / University of Colombo. Abstract: Renal transplantation is a complex surgical procedure requiring meticulous anesthetic planning to ensure patient safety and optimal graft function. This review comprehensively examines the various aspects of anesthesia management during renal transplantation, including preoperative, intraoperative, and postoperative care. Key components of preoperative optimization include the management of anemia using erythropoiesis-stimulating agents and the identification of potential risks to reduce perioperative complications. Intraoperative management focuses on hemodynamic monitoring, volume maintenance, and the careful selection of anesthetic techniques, with particular emphasis on neuromuscular monitoring and maintaining mean arterial pressure within the range of 80-110 mmHg. Postoperative care highlights the importance of multimodal analgesia, prevention of delirium, and the implementation of enhanced recovery after surgery (ERAS) protocols to promote optimal recovery. The review underscores the importance of collaboration among surgical teams, anesthesiologists, and healthcare professionals in achieving successful renal transplantation outcomes. Keywords: Renal transplantation, Anesthetic management, Preoperative care, Intraoperative monitoring, Postoperative recovery, Hemodynamic control, Neuromuscular monitoring, Enhanced Recovery After Surgery (ERAS), Anemia management Key Points: Preoperative Optimization: Identification and management of perioperative risks. Anemia management using erythropoiesis-stimulating agents for hemoglobin levels < 9-10 g/dl. Intraoperative Management: Continuous hemodynamic monitoring and volume status maintenance. Neuromuscular monitoring and use of appropriate anesthetic techniques. Maintenance of mean arterial pressure between 80-110 mmHg. Perioperative glycemic control, temperature management, and diuretic use. Postoperative Care: Implementation of multimodal analgesia. Prevention of postoperative delirium. Enhanced Recovery After Surgery (ERAS) protocols to improve patient outcomes. Collaboration: Importance of teamwork among surgeons, anesthesiologists, and healthcare professionals to ensure successful renal transplantation outcomes. Introduction: Renal transplantation is the most common surgical intervention for end-stage renal disease (ESRD), a condition caused by various underlying diseases. Since the first successful renal transplantation in 1954, the procedure has evolved, with one-year survival rates for deceased-donor grafts now exceeding 90% in many countries. The prevalence of renal transplantation varies globally, with living donor procedures more common in some regions, while deceased donor transplants predominate in others. In South Korea, the history of renal transplantation began with the first living donor transplant in 1969, followed by the first deceased donor transplant in 1979. The success rates have steadily improved, with a one-year survival rate of 95.9% for deceased donors and 98.8% for living donors reported in 2021. Renal transplantation is recommended for ESRD patients, particularly those with nephropathy related to hypertension and diabetes, which are the leading indications in the United States. Given the complexity of renal transplantation, detailed anesthetic planning is critical to ensure patient safety and the optimal functioning of the transplanted kidney. This