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Enhanced Recovery After Kidney Transplantation: 48 Hour Length of Stay in Living and Deceased Donor Transplant Recipients.

O. Ojogho, J. Mejia, S. Bani-Hani, B. Dieter, R. Carson.

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

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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).

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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.

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