Enhanced Recovery After Kidney Transplantation Surgery

• Enhanced recovery after surgery (ERAS) protocols are not limited to particular surgical intervention, allowing for wider implementation, including in kidney transplantation.
• ERAS protocol, modified to address kidney transplantation unique issues, is feasible and renders low morbidity and reasonable readmission rates.
• Apart from standard ERAS measures, disease-specific interventions should be included in a modified ERAS protocol for kidney transplant recipients.

BackgroundEnhanced recovery after surgery (ERAS) protocols have gained widespread recognition in general surgery, decreasing the length of hospital stay while maintaining equivalent or lower morbidity and increased patient satisfaction. The feasibility of the ERAS protocol has not been studied in kidney transplantation. In this single-center retrospective case series, we describe the outcomes of 45 consecutive deceased-donor kidney transplant recipients subjected to a modified ERAS protocol, and we discuss the potential for future developments.MethodsIncluded in the analysis were 45 consecutive deceased-donor kidney transplant recipients from August 2014 to July 2015 in the John Paul II Krakow Specialist Hospital, Krakow, Poland. All patients were subjected to a modified ERAS protocol. The primary outcomes were length of hospital stay and mortality and morbidity rates. A surrogate composite criterion for discharge was ability to attend the transplant clinic weekly with no need for dialysis. The secondary outcome was the rate of unplanned readmissions within the 1st 3 months after transplantation.ResultsThe median hospital stay was 10 days (range, 6–46). There were no deaths or acute coronary or thromboembolic events. Serious complications requiring surgery occurred in 6.6% of recipients. Three-month graft survival was 97.8%. The unplanned readmission rate was 8.9%.ConclusionsERAS protocol is feasible in deceased donor kidney transplantation and renders low morbidity rates and reasonable readmission rate. Further reduction of the length of the hospital stay can be expected with health care system financial policies.