Cardiovascular disease (CVD) is an important comorbidity of chronic kidney disease, and reducing cardiovascular events in this population is an important goal for the clinicians who care for chronic kidney disease patients. The high risk for CVD in transplant recipients is in part explained by the high prevalence of conventional CVD risk factors (e.g., diabetes, hypertension, and dyslipidemia) in this patient population. Current transplant success allows recipients with previous contraindications to transplant to have access to this procedure with more frequency and safety. Herein we provide a series of eight patients with dilated cardiomyopathy with poor ejection fraction posted for live donor renal transplantation which was successfully performed under regional anesthesia with sedation. 1. Introduction End stage renal disease (ESRD) [1] is the last stage of chronic kidney disease when glomerular filtration rate is less than 15？mL/min/1.73？m2 and renal replacement therapy is essential to sustain life. Renal transplantation is the treatment of choice [1]. Most ESRD patients are anuric or oliguric. Chronically increased intravascular volume may lead to concentric hypertrophy or dilated cardiomyopathy. Dilated cardiomyopathy (DCM) is defined by the presence of (a) fractional myocardial shortening <25% and/or ejection fraction <45% and (b) left ventricular end diastolic diameter >117% excluding any known cause of myocardial disease [2]. Management of patients with severe cardiomyopathies and left ventricular dysfunction is associated with a high morbidity and mortality. LV ejection fraction of ≤35% is considered to be an optimal predictor of postoperative cardiac events [3]. Reduced kidney function is an independent risk factor for adverse postoperative cardiovascular outcomes including myocardial infarction, stroke, and progression of heart failure. An evaluation of 852 subjects undergoing major vascular surgery demonstrated an increase in mortality when serum creatinine was ≥2.0？mg/dL [3]. The patients presented here had dual problems of abnormal physiology due to ESRD and ventricular dysfunction due to DCM, thereby further increasing perioperative cardiovascular risk. We describe successful conduction of renal transplant surgery in eight ESRD patients with DCM using combined spinal epidural technique (CSE). 2. Cases Proper preoperative assessment of all eight haemodialysis dependent ESRD patients was done. Relevant details are provided in Table 1. Table 1: Important patient information. The patients were informed of their high risk status for
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