Background and Aims Anesthesia for kidney transplant on a patient with severe mitral regurgitation is a true challenge since a judicious hemodynamic management is needed to avoid pulmonary edema and ensure optimized reperfusion of the transplanted organ. A 49-year-old Caucasian female with chronic severe mitral regurgitation was scheduled for urgent kidney transplant due to end-stage renal disease caused by lupus nephritis.

Methods We performed the first described continuous spinal anesthesia in a patient with chronic severe mitral regurgitation undergoing cadaver donor kidney transplant. Echocardiography and seriated blood gas analysis were monitored.

Results Cardiac output monitoring confirmed absence of impaired ventricular function or worsening of mitral regurgitation during the installation of subarachnoid block. We used a total of 10 mg bupivacaine and 10 mg sufentanyl and had no need of vasopressor use during block installation and all the intra-operative period. No sedation was administered.

Conclusions Continuous spinal anesthesia provides potential advantages over other forms of neuraxial anesthesia, since low doses of local anesthetic could be titrated during all the surgical procedure with minimal hemodynamic impact, ensuring a reliable block with quick onset and low risk of local anesthetic toxicity. In the case allowed adequate hemodynamic management to avoid mitral regurgitation deterioration and optimize graft perfusion. Continuous spinal anesthesia was suitable for the surgical procedure and contributed to an individualized management essential to the outcome of the patient.