**5.4. Outpatient and esthetic surgery**

With shorter medical procedure duration and fewer complications, there is growth in popularity of outpatient or ambulatory surgery. Procedures performed are broad in scope: knee, shoulder, spine and eye surgery (cataract, laser surgery), plastic surgery, some types of esthetic surgery, and upper gastrointestinal endoscopy and colonoscopy [114].

Improved immunosuppression and lifespans have afforded solid organ transplant recipients the opportunity to seek outpatient and esthetic surgery. Most commonly performed procedures are soft tissue excisions with local flap coverage, facelifts, breast augmentation, and abdominoplasty. Among solid organ transplant recipients, kidney transplant recipients most often underwent plastic surgery, accounting for over 68% [115]. The complication rate is very low and ranges from 4 to 8% [116]. Delayed wound healing or wound disruption is reported as the most common complication and is associated with immunosuppression therapy, such as steroids [117].

It is extraordinarily important to manage these patients with a multidisciplinary approach. They should obtain clearance from the transplant surgeon and from the organ-specific specialist. The anesthesiologist should be familiar with the organ-specific needs in the perioperative period (i.e. maintaining preload for heart transplant patients, judicious fluid management in the renal patient, and avoidance of volatile anesthetics in liver transplants) to avert unintended consequences. It is more reasonable to use of general anesthesia over regional in the heart transplant patients. Perioperative antibiotic prophylaxis and stress-dose steroids should be administered prior to surgery. NSAIDs should be avoided in postoperative pain regimen [118].

Elective esthetic surgery can be performed safely in patients with a history of solid organ transplantation after a careful patient selection and multidisciplinary approach. These patients can potentially experience significant improvements in their quality of life with low morbidity.
