Benefits of multimodal enhanced recovery pathway in patients undergoing kidney transplantation
Corresponding Author
Kevin A. Espino
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
Correspondence
Kevin Espino, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Email: [email protected]
Search for more papers by this authorJ. Reinier F. Narvaez
University at Buffalo Department of Surgery, Buffalo, NY, USA
Search for more papers by this authorMichael C. Ott
Erie County Medical Center Regional Transplantation and Kidney Care Center of Excellence, Buffalo, NY, USA
Search for more papers by this authorLiise K. Kayler
University at Buffalo Department of Surgery, Buffalo, NY, USA
Erie County Medical Center Regional Transplantation and Kidney Care Center of Excellence, Buffalo, NY, USA
Search for more papers by this authorCorresponding Author
Kevin A. Espino
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
Correspondence
Kevin Espino, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Email: [email protected]
Search for more papers by this authorJ. Reinier F. Narvaez
University at Buffalo Department of Surgery, Buffalo, NY, USA
Search for more papers by this authorMichael C. Ott
Erie County Medical Center Regional Transplantation and Kidney Care Center of Excellence, Buffalo, NY, USA
Search for more papers by this authorLiise K. Kayler
University at Buffalo Department of Surgery, Buffalo, NY, USA
Erie County Medical Center Regional Transplantation and Kidney Care Center of Excellence, Buffalo, NY, USA
Search for more papers by this authorAbstract
Background
Use of enhanced recovery after surgery (ERAS) pathways to accelerate functional recovery and reduce length of stay (LOS) has rarely been investigated in kidney transplantation (KTX).
Materials and Methods
Consecutive adult isolated KTXs between July 2015 and July 2016 (ERAS, n = 139) were compared with a historical cohort between January 2014 and July 2015 (HISTORIC, n = 95).
Results
Enhanced recovery after surgery recipients were significantly more likely to receive kidneys that were non-local (56.1% vs 4.2%), higher Kidney Donor Profile Index (36-85, 58.4% vs 45.2%; >85, 15.2% vs 10.7%), cold ischemia time ≥30 h (62.4% vs 4.7%), induced with antithymocyte globulin (97.1% vs 87.4%), and to develop delayed graft function (46.4% vs 25.0%). LOS was shorter by 1 day among ERAS (mean 4.59) compared to HISTORIC patients (mean 5.65) predominantly due to a shift in discharges within 3 days (32.4% vs 4.2%); 30-day readmission to the hospital (27.3% vs 27.4%) or emergency room visit (9.4% vs 7.4%) was similar. There was one 30-day death in the ERAS group and none in the HISTORIC group. Return to bowel function and early meal consumption were significantly associated with ERAS, however, with somewhat higher diarrhea and emesis rates.
Conclusion
ERAS following KTX correlated with lower LOS without change in readmissions or ER visits despite higher delayed graft function rates.
CONFLICT OF INTEREST
The authors declare no conflict of interest.
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