*Purpose: Kidney and simultaneous pancreas-kidney (SPK) transplant recipients can have prolonged post-operative hospitalization due to edema, delayed mobilization, and delayed graft function. Traditionally, TED stockings with intermittent pneumatic compression devices (TED/IPC) are placed preoperatively to improve venous return during the perioperative period and to prevent deep vein thrombosis (DVTs). The objective of this trial was to evaluate the effects of TED/IPC versus muscle pump activator (MPA) on factors which could reduce post-operative complications and decrease length of stay.

*Methods: In this single center, prospective, randomized-controlled trial, 221 kidney or SPK transplant recipients (Donation after Neurological Death=109, Living Donor=52, Donation after Cardiac Death=60) were randomized to either wearing TED/IPC or MPAs for 7 days post-operatively. Post-operative care and discharge planning was performed by an independent nephrology team. Groups were compared with respect to days in hospital, post-operative lower limb edema, weight, mobility, urine output, serum creatinine, delayed graft function (DGF), need for dialysis, and renal blood flow.

*Results: Patients assigned to wear the MPA device were found to have a significantly shorter hospital stay compared to the TED/IPC group (8.15 vs 9.36 days, p=0.038). Markers for post-operative fluid retention including changes in mid-calf leg circumference and patient weight were significantly lower in the MPA group (p=0.001 and p=0.003, respectively). The TED/IPC group were overall less mobile post-operatively with less total steps recorded on a pedometer (p=0.009). The MPA device improved blood flow to the renal allograft with higher peak systolic velocity in the renal arcuate artery (p=0.001) and higher femoral vein velocity (p=0.001). This corresponded to significantly higher urine output in the MPA group (p=0.003) but objective measures of renal function including: frequency of DGF, number of dialysis runs, and serum creatinine were not different between the two groups.

*Conclusions: Post-operative use of the MPA device decreases duration of hospitalization after kidney transplantation. This may be attributable to improved renal blood flow to the transplant allograft and thus increased urine output and decreased fluid retention. Better post-operative mobility likely reduced the risk of developing DVTs and other complications.

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