Vol. 7, Issue 2, Part B (2025)

We report the case of a young female with end-stage renal disease (ESRD) secondary to vesicoureteral reflux in a solitary kidney, who successfully underwent cadaveric donor kidney transplantation despite severely depressed left ventricular systolic function (ejection fraction [EF] 10-15%). Her course was complicated by multiple vascular access failures, a prior right atrial thrombus, and dependence on peritoneal dialysis. The coexistence of ESRD and severe dilated cardiomyopathy posed an extraordinary anesthetic challenge. Meticulous multidisciplinary planning, judicious drug selection, restrictive fluid management, and proactive hemodynamic support enabled a stable intraoperative course and favourable recovery. Remarkably, at three-month follow-up, her EF had improved to 60%, signifying both myocardial and graft functional recovery. This case highlights that renal transplantation can be safely performed in carefully selected patients with severe cardiac dysfunction when managed through individualized anesthetic and perioperative strategies.