*Purpose: Enhanced recovery after surgery (ERAS) is an established multimodal approach to perioperative care. However, ERAS in renal transplantation isn’t common practice. ERAS involving early mobilisation, fluid restriction, opiate minimisation, local anaesthetic wound infiltration and early urinary catheter removal is now implemented in our Unit. The study aim was to assess whether ERAS decreased length of stay (LoS) in renal transplant recipients.

*Methods: Outcomes were compared between all consecutive renal transplant recipients in 2010 and consecutive renal transplant recipients in 2018, before and after implementation of ERAS. Data were extracted from a prospectively recorded database. The primary outcome was median LoS in hospital.

*Results: There were 73 renal transplants in 2010 and 115 in 2018. Compared to 2010, in 2018 there was a significant increase in donor age (47 vs.54, p<0.0001) and donation after circulatory death (0 vs. 29%, p<0.0001). Although there was no change in the proportion of living donors (59 vs.50%, p=0.32), in 2018 there were more blood group incompatible living donors (0 vs.7%, p=0.21). Compared to 2010, in 2018 there was a significant increase in recipient age (43 vs.54, p=0.0002), diabetic nephropathy (5 vs.16%, p=0.03) and BMI>35kg/m2 (0 vs.9%, p=0.02). Between 2010 and 2018 there was a significant decrease in cold ischemia for deceased donor transplants (1260 vs.669 minutes, p<0.0001), and a significant increase in time to graft function across all donor types (10% creatinine drop, 2.6 vs.5.1 days, p=0.009). Between 2010 and 2018 there was a significant decrease in LoS from 12 to 7 days (p<0.0001). Decreased LoS was observed in the context of a significant increase in discharge creatinine (110 vs.170mmol/L, p<0.0001).

*Conclusions: Implementation of ERAS significantly decreased LoS in renal transplant recipients despite increasingly complex donor and recipient profiles. Poorer graft function at the time of earlier discharge from hospital was not a barrier to reducing LoS.

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