*Purpose: Enhanced recovery after surgery (ERAS) is a multi-modal perioperative care pathway designed to facilitate early recovery after major surgery by maintaining preoperative body composition and physiological organ function and modifying the stress response induced by surgical exposure. Use of ERAS has not been well studied in kidney transplant surgery.

*Methods: This is a single-center, retrospective analysis comparing the outcomes of the first 10 kidney transplantation recipients subjected to the modified ERAS protocol to 20 recipients operated prior to ERAS with traditional standard of care. Our ERAS protocol includes: I) Preoperative: patient education, reduced duration of fasting with preoperative carbohydrate loading (if not diabetic) and oral Tylenol. II) Intraoperative: 1) Multi-modal analgesia including: sub fascial (Bupivacaine 0.5 with epi 1: 200,000) injections, Morphine 4 mg or Acetaminophen 1 g intravenous towards the end of case. 2) Antiemetics including Zofran 4 mg intravenous when closing. 3) intravenous fluid restricted to 5 ml/kg (Hydration should be monitored with urine output, non-invasive measures of cardiac output, if boluses are needed for hydration or increasing blood pressure at the time of re-perfusion, albumin 5% is preferred). III) Postoperative: narcotic-free pain regimen with acetaminophen.

*Results: Median hospital stay for ERAS patients was 2 days. Overall pain scores were significantly lower in the ERAS group (peak pain score 5 vs. 10, p< 0.014; morning after surgery pain score 4 vs. 8, p=0.011; lowest pain score 0.0 vs. 3.0, p=0.012). There was no significant difference in duration of surgery between both groups. There was no significant difference in graft function in both groups. All ERAS patients had 4 hours bed rest versus 24-hour bed rest in other group. Eating regular diet occurred significantly earlier in the ERAS group (in first versus second day postoperatively in traditional group). ERAS patients were fully ambulating in first day postoperatively versus 2^nd day postoperatively in traditional group. ERAS patients had significantly earlier bowel movement.

*Conclusions: Application of an ERAS protocol in kidney transplantation is feasible with some modifications to adapt unique dynamics of transplantation. In our experience it was associated with improved pain scores and earlier ambulation and toleration of regular diet. Using ERAS pathways in kidney transplantation is associated with increased patients’ satisfaction.

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