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Impact of Enhanced Recovery after Surgery Protocols on Robotic Living Kidney Donor Outcomes: A Single Center Experience

B. Ruch, A. Sharma, J. Amery, C. Bhati, A. Khan, A. Cotterell, M. Scott, M. Levy

Virginia Commonwealth University, Richmond, VA

Meeting: 2020 American Transplant Congress

Abstract number: A-033

Keywords: Donation, Kidney transplantation

Session Information

Session Name: Poster Session A: Kidney Living Donor: Other

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Traditional management of living donor nephrectomies includes intraoperative volume loading to maintain renal perfusion and urine output. Recently our center initiated fluid restriction as part of an enhanced recovery after surgery (ERAS) protocol for all robotic living donor nephrectomies (RLDN). Outcomes for robotic kidney donors managed with intraoperative fluid restriction has not previously been reported.

*Methods: A retrospective analysis of all RLDN performed at our single center from 01/2016 to 10/2019 was performed. Robotic nephrectomy outcomes Pre-ERAS (2016-2018) and post-ERAS protocol initiation (2019) were compared using standard t-test for unequal variances. A p-value < .05 was considered significant.

*Results: A total of 132 robotic donor nephrectomies were performed (98 Pre-ERAS and 34 Post-ERAS). The two groups were comparable in terms of age, gender, BMI and race (Table 1). Post-ERAS there was a statistically significant decrease in hospital stay (3.15 ± 0.50 days Post-ERAS vs 3.4 ± 0.68 days Pre-ERAS, p-value 0.03). There was a significant decrease in intraoperative fluid administration (2005.9 ± 573.63 mL vs 3569.3 ± 929.43 mL, p-value < 0.001) and urine output (726.62 ± 318.33 mL vs 1085.85 ± 437.86 mL, p-value < 0.001) but no negative effect on postoperative donor creatinine or glomerular filtration rate (GFR).

*Conclusions: Implementation of enhanced recovery for robotic living donor nephrectomies significantly decreased hospital stay. Intra operative fluid restriction did not negatively affect post-operative renal function in our robotic donors. Further studies are needed to evaluate the impact of kidney donor ERAS protocols on renal allograft outcomes in recipients.

Pre-ERAS versus Post-ERAS RLDN
Pre-ERAS (N = 98) Post-ERAS (N = 34) p-value
Age (mean ±SD) 42.3 ± 13.0 43.6 ± 11.5 0.57
BMI (mean ±SD) 27.2 ± 4.4 26.2 ± 4.4 0.28
Female (%) 66.3 % 61.8 % ns
Caucasian (%) 70.4 % 70.6 % ns
Pre-ERAS versus Post-ERAS Intra and Postoperative Parameters
Pre-ERAS (N = 98) Post-ERAS (N = 34) p-value
Intra-op fluids (mL, mean ±SD) 3569.3 ± 929.43 2005.9 ± 573.63 <0.001
Intra-op urine output (mL, mean ±SD) 1085.85 ± 437.86 726.62 ± 318.33 <0.001
Hospital stay (days, mean ±SD) 3.4 ± 0.68 3.15 ± 0.50 0.03
S. Creatinine (mg/dL) Pre-donation 0.82 ± 0.15 0.84 ± 0.16 0.43
S. Creatinine (mg/dL) At discharge 1.33 ± 0.28 1.36 ± 0.28 0.61
GFR (mL/min) Pre-donation 100.61 ± 14.55 98.32 ± 15.69 0.46
GFR (mL/min) At discharge 58.66 ± 12.24 57.53 ± 10.95 0.62
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To cite this abstract in AMA style:

Ruch B, Sharma A, Amery J, Bhati C, Khan A, Cotterell A, Scott M, Levy M. Impact of Enhanced Recovery after Surgery Protocols on Robotic Living Kidney Donor Outcomes: A Single Center Experience [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/impact-of-enhanced-recovery-after-surgery-protocols-on-robotic-living-kidney-donor-outcomes-a-single-center-experience/. Accessed May 11, 2025.

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