Benefits of multimodal enhanced recovery pathway in patients undergoing kidney transplantation

• Published in: Clinical transplantation Vol. 32; no. 2
• Main Authors: Espino, Kevin A., Narvaez, J. Reinier F., Ott, Michael C., Kayler, Liise K.
• Format: Journal Article
• Language: English
• Published: Denmark 01.02.2018
• Subjects: Adult; Aged; enhanced recovery; Female; Follow-Up Studies; Glomerular Filtration Rate; Graft Rejection - prevention & control; Graft Survival; Humans; Kidney Failure, Chronic - surgery; Kidney Function Tests; kidney transplant; Kidney Transplantation - rehabilitation; length of stay; Length of Stay - statistics & numerical data; Male; Middle Aged; Patient Readmission; Perioperative Care - methods; Postoperative Complications - prevention & control; Prognosis; Recovery of Function; Retrospective Studies; Risk Factors; kidney transplant; length of stay; enhanced recovery
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.13173

Background Use of enhanced recovery after surgery (ERAS) pathways to accelerate functional recovery and reduce length of stay (LOS) has rarely been investigated in kidney transplantation (KTX). Materials and Methods Consecutive adult isolated KTXs between July 2015 and July 2016 (ERAS, n = 139) were compared with a historical cohort between January 2014 and July 2015 (HISTORIC, n = 95). Results Enhanced recovery after surgery recipients were significantly more likely to receive kidneys that were non‐local (56.1% vs 4.2%), higher Kidney Donor Profile Index (36‐85, 58.4% vs 45.2%; >85, 15.2% vs 10.7%), cold ischemia time ≥30 h (62.4% vs 4.7%), induced with antithymocyte globulin (97.1% vs 87.4%), and to develop delayed graft function (46.4% vs 25.0%). LOS was shorter by 1 day among ERAS (mean 4.59) compared to HISTORIC patients (mean 5.65) predominantly due to a shift in discharges within 3 days (32.4% vs 4.2%); 30‐day readmission to the hospital (27.3% vs 27.4%) or emergency room visit (9.4% vs 7.4%) was similar. There was one 30‐day death in the ERAS group and none in the HISTORIC group. Return to bowel function and early meal consumption were significantly associated with ERAS, however, with somewhat higher diarrhea and emesis rates. Conclusion ERAS following KTX correlated with lower LOS without change in readmissions or ER visits despite higher delayed graft function rates.