BACKGROUND: Enhanced recovery after kidney transplantation is a desired outcome with potential value-enhancing benefits of reduced length of stay (LOS), costs, and risk of nosocomial infectious complications.

PURPOSE: In a previous report we demonstrated the feasibility of ERAS-driven reduction in LOS. In the present study, we expanded our cohort and sought to examine ERAS impact on LOS across multiple donor organ sources, as well as 1 year patient and graft survival.

PATIENTS AND METHODS: The ERAS protocol utilized multifaceted measures pre, intra, and postoperatively targeted towards reducing LOS, including a unique "Minimal Access" incision. Our protocol was initiated in early 2012 but was not fully matured until early 2013. A cohort of patients from 7/1/2013 to 9/30/2017 who received the ERAS protocol (ERAS Cohort) represented the study population (N=195). A similar cohort from 7/1/2009-6/30/2010 who did not receive the ERAS protocol (Non-ERAS Cohort) was used as a comparison group (n=49). LOS was categorized into six categories (2, 3, 4, 5, and >5 days). Differences between cohorts were analyzed using chi-square tests. Kaplan-Meier estimators were used to examine 1 year patient survival and graft survival in the ERAS and non-ERAS cohort.

RESULTS: The median LOS for all donor types was 3 days and 5 days in the ERAS and Non-ERAS Cohort, respectively (p<0.001). The median LOS for patients receiving living donor kidneys was 2 days and 4 days in the ERAS and Non-ERAS Cohort, respectively (p<0.001). The median LOS for patients receiving deceased donor kidneys was 3 days and 5 days in the ERAS and Non-ERAS Cohort, respectively (p<0.001). Amongst the ERAS cohort, the median length of stay was 3 days for the donation after cardiac death and standard criteria donors, and 2 days amongst the living donors. The 30-day readmissions rate for all donors in the ERAS Cohort was 20.1% compared to 31% for the national average and 8.2% for the Non-ERAS cohort. One year patient survival was 99% and 100% in the ERAS and non-ERAS cohort, respectively (p=0.57). One year graft survival was 99% and 100% in the ERAS and non-ERAS cohort, respectively (p=0.42).

CONCLUSION: Enhanced recovery after kidney transplantation reduced LOS while maintaining excellent graft and patient survival, irrespective of donor source. Additional, larger, studies are necessary to establish the role of ERAS in kidney transplantation.

CITATION INFORMATION: Ojogho O., BaniHani S., Nemr S., Dieter B., Joyce A., Mejia J. Enhanced Recovery after Kidney Transplantation Regardless of Donor Organ Source Am J Transplant. 2017;17 (suppl 3).

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