**1. Introduction**

The number of solid organ transplants performed worldwide is ever increasing. The improved survival rates are the result of well-established surgical techniques and effective immunosuppressive therapy. All this has led to an increase in number of patients who present for either elective or emergency non-transplant surgery [1, 2]. Laparotomy for small bowel obstruction, hip arthroplasty given the increased risk of fracture and avascular necrosis as a result of chronic steroid use causing bone demineralization and osteoporosis, lymph node excision and biopsy because of increased risk of lymphoproliferative disease, native nephrectomy in kidney transplant recipients, bronchoscopy in lung recipients, biliary tract interventions in liver recipients, and abscess drainage because of increased risk of infection are just a few of

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

the increased surgical needs in this population. These patients cannot always return to the transplant facility for surgery, so it is incumbent on all anesthesiologists to review perioperative issues associated with transplantation.

Perioperative anesthetic management in majority of recipients is similar to the standard practice for any patient. However, we must bear in mind some essential considerations: problems of allograft denervation, the adverse effects of immunosuppression and its interaction with anesthetic drugs, the risk of infection, and the potential for organ rejection. When transplant recipients require nontransplant surgery, immune competence can be altered from the stress of surgery, acute illness, or disruption of the regimen by inexperienced providers [3].

Preoperative assessment of any transplant recipient undergoing non-cardiac surgery should focus on graft function and rejection, risks of infection, and function of other organs, particularly those that may be compromised due to either immunosuppressive therapy or dysfunction of the transplanted organ itself and drug interactions. There is no ideal anesthetic for use in organ transplant recipients. However, certain principles can be applied to all transplant patients who undergo anesthesia and surgery [4].

In this chapter, we will give an overview of immunosuppressive therapy and its interaction with anesthetic drugs as well as considerations regarding specific transplanted organs (heart, lungs, liver, kidney, pancreas, and intestine).
