Enhanced Recovery After Kidney Transplantation: 48 Hour Length of Stay in Living and Deceased Donor Transplant Recipients.
Kidney Transplant Program, Providence Sacred Heart Medical Center and Chldren's Hospital, Spokane, WA.
Meeting: 2016 American Transplant Congress
Abstract number: 427
Keywords: Graft survival, Kidney transplantation, Length of stay, Outcome
Session Information
Date: Tuesday, June 14, 2016
Session Name: Concurrent Session: Kidney: Length of Stay/Readmission
Session Time: 2:30pm-4:00pm
Presentation Time: 2:42pm-2:54pm
Location: Room 302
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 :Using an Enhanced Recovery After Surgery (ERAS)-type protocol, we sought to improve our program specific outcomes, especially, LOS. PATIENTS AND METHODS: The ERAS protocol utilized multifaceted measures pre, intra, and postoperatively targeted towards reducing LOS
| Preoperative | Preoperative | Postoperative |
| Preoperative patient education | Antibiotics before incision | Adherence to kidney transplant protocols |
| Clinical provider education | Thromboprophylaxis | Optimal analgesic regimen |
| Multidisciplinary patient selection | Minimally invasive surgery (≤10 cm incision) | No nasogastric tube |
| Postop nausea and vomitting prophylaxis | Early feeding | |
| Goal-directed fluid therapy | Early mobilization | |
| Avoid routine systemic Heparin for vascular anastomosis | Post discharge clinic visit in 24-48 hours |
. Our protocol was initiated in early 2012 but was not fully matured until early 2013. A cohort of patients from 7/1/2013 to 6/30/2014 who received the ERAS protocol (ERAS Cohort) is most representative for our study population (N=46), with at least 1 year follow-up period. Immunosuppression was thymoglobulin induction with Tacrolimus-based triple therapy. 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. LOS was categorized into six categories (2, 3, 4, 5, and >5 days). Differences between cohorts were analyzed using chi-square tests. RESULTS: The median LOS for all donor types was 2 days in the ERAS Cohort compared to 5 days in the Non-ERAS Cohort (p<0.001). The median LOS for patients receiving living donor kidneys was 2 days in the ERAS Cohort compared to 4 days in the Non-ERAS Cohort (p=0.003). The median LOS for patients receiving deceased donor kidneys was 2 days in the ERAS Cohort cohort compared to 5 days in the Non-ERAS Cohort (p=0.01). Graft and patient survival was 100% at 1 year in both cohorts. CONCLUSION: Enhanced recovery after kidney transplantation and reduced LOS are feasible using a structured protocol. Additional, larger, studies are necessary to establish the role of ERAS in kidney transplantation.
CITATION INFORMATION: Ojogho O, Mejia J, Bani-Hani S, Dieter B, Carson R. Enhanced Recovery After Kidney Transplantation: 48 Hour Length of Stay in Living and Deceased Donor Transplant Recipients. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Ojogho O, Mejia J, Bani-Hani S, Dieter B, Carson R. Enhanced Recovery After Kidney Transplantation: 48 Hour Length of Stay in Living and Deceased Donor Transplant Recipients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/enhanced-recovery-after-kidney-transplantation-48-hour-length-of-stay-in-living-and-deceased-donor-transplant-recipients/. Accessed April 20, 2021.« Back to 2016 American Transplant Congress