Background: Use of Enhanced Recovery After Surgery (ERAS) pathways have been shown to improve patient recovery in several surgical specialties; however, its' effectiveness in kidney transplantation (KTX) has rarely been investigated. We hypothesized that our ERAS pathway would accelerate functional recovery and shorten hospitalization of KTX recipients. Our ERAS pathway is characterized by early foley removal, accelerated diet/bowel function, and minimization of narcotics. Methods: Consecutive adult kidney-only transplant recipients at our center between 7/2015 to 7/2016 (ERAS) were compared with a historical cohort between 1/2014-7/2015 (HISTORIC). Primary outcomes were length of stay (LOS), 30-day readmission to hospital or emergency room, and 30-day death. Results: There were 139 ERAS and 95 HISTORIC cases. ERAS recipients were significantly more likely to receive kidneys that were non-local (56.1% vs. 4.2%, p<0.01), higher KDPI (36-85, 58.4% vs. 45.2%; >85, 15.2%vs. 10.7%, p=0.03), cold ischemia time ≥ 30h (56.2% vs. 4.2%, p<0.01), induced with antithymocyte globulin (97.1% vs. 87.4%, p<0.01), and to develop delayed graft function (43.3 vs. 22.1%, p<0.01). Other demographic, donor, and transplant characteristics were similar. Length of stay was shorter by 1 day amongst ERAS patients (mean 4.59; median 4) compared to HISTORIC patients (mean 5.65; median 4) predominantly due to a shift in discharges within 3 days (32.4% vs. 4.2%, p<0.01). Readmission within 30 days to the hospital (29.0% vs. 29.5%, p=0.94) or visits to emergency room (9.4% vs. 7.4%, p=0.58) were similar. There was one 30-day death in the ERAS group and none in the HISTORIC group. Secondary endpoints including return to bowel function (61.2% vs. 31.6%, p<0.01) and early meal consumption (44.6% vs. 12.6%, p<0.01) were significantly associated with ERAS; but not zofran administration beyond post operative day 2 (62.6% vs. 66.3%, p=0.56), diarrhea (20.9% vs. 11.6%, p=0.06), emesis (15.8% vs. 8.4%, p=0.10), peak pain level on post operative day 2 < 7 (38.1% vs. 36.8%, p=0.84), and pain mean level of post operative day < 5 (63.3% vs. 65.3%, p=0.76). Conclusion: Use of an ERAS pathway in KTX recipients correlated with lower length of stay without change in readmissions or ER visits despite higher case complexity.

CITATION INFORMATION: Espino K, Kayler L. Benefits of Multimodal Enhanced Recovery Pathway in Patients Undergoing Kidney Transplantation. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress