Introduction: Chronic Kidney Disease (CKD) has diverse etiologies but regardless them the outcome changes when patients receive a renal transplantation, for most it has the potential to increase quality of life and improve survival. Since transplanted patients usually have co-morbid conditions, pre-surgical assessment, optimization of health status (premedication and pharmacological adjustment) monitoring and intraoperatory anesthetic management including anesthetic technique, drugs employed and hemodynamic stability are essential to achieve optimal function of the graft. Objective: to evaluate medical available literature concerning presurgical anesthetic assessment, intraoperatory and postoperatory anesthetic management of patients undergoing renal transplantation. Review Criteria: A bibliographic search was made in MEDLINE, OVID and LILIACS without language or design limits. Available evidences from February 1991 to February 2011 were taken. Articles about anesthesia in renal transplantation were included. Information quality was assessed according design type with “Critical Appraisal Skills Program” (CASP-UK) tools. Epidemiologic data of renal transplantation surgery in Colombia were obtained from Social Protection Ministry and FOSYGA pages. Results: Regarding prognosis, CKD mortality increases with dialysis (51%; RR: 0.51; CI 95% > 0.49-0.53; P < 0.001) and with its duration (22% if it is longer than 3 years and 3% it if less, P = 0, 01), whereas transplantation reduces it (31%; RR: 0.51; CI 95% > 0.49-0.53; P < 0.001) and enhances survival (P < 0.001). Receptor mortality, functionality and graft lifetime are influenced by donor type (immediate diuresis with live donors, P < 0,05), hydration (70 to 90 ml/Kg), early diuresis (13% of mortality at one year if delayed and reduction of graft lifetime 20 to 40%, p < 0.04). When comparing diuresis level and creatinin depuration, perfusion and renal function, there were no significant differences between general anesthesia and regional anesthesia (p > 0.05). Nevertheless, postoperatory analgesia was better with epidural anesthesia (p < 0.001). Conclusion: Thorough examination of the patient and optimization of the overall health status contributes to graft optimal function and patients' survival. Regional anesthesia has better control over postoperatory pain, but it has no effect on the prognosis. The intraoperatory maintenance of an appropriate hydration (60 - 90 ml/Kg) enhances flux and renal perfusion, which allows early functionality of graft. This, together with receiving the graft from a living donor are considered good prognosis factors, moreover they reduce receptor mortality, and improve graft lifetime Mesh:anesthesiology, general anesthesia, regional anesthesia, kidney transplantation, perioperative review, complication.