Four kidneys and a tumor: Laparoscopic radical nephrectomy in a renal transplant recipient

Ever since the advent of organ transplantation, the survival rate and future encounter of recipients with anesthesiologists has increased. There have been several case reports and reviews on anesthesia for renal transplant recipients. We present a unique case of a patient who had previously undergone double renal transplantation, presenting to the anesthesiologist with four kidneys for laparoscopic radical nephrectomy for renal cell carcinoma. To the best of our knowledge, there has been no reported case of a postrenal transplant patient with four kidneys presenting for minimally invasive radical nephrectomy. Hemodynamic stability, preservation of renal function, careful choice of anesthetic agents, protection of fistula sites, complete asepsis, institution of extensive monitoring, cautious positioning, and use of ultrasound-guided regional block for pain management are some of the clinical pearls gained from this unique and rare case.