Campsen Jeffrey, Zhang Chong, Presson Angela, Goodale Mariah, Pan Gilbert, Scutts Sarah, Rofaiel George, Kim Robin
Department of Surgery, Division of Transplantation and Advanced Hepatobiliary Surgery, University of Utah School of Medicine/Huntsman Cancer Institute, Salt Lake City, USA.
Department of Medicine, Division of Epidemiology, University of Utah School of Medicine/Huntsman Cancer Institute, Salt Lake City, USA.
Cureus. 2020 Aug 26;12(8):e10056. doi: 10.7759/cureus.10056.
Background and Objective Opioid exposure is a concern after live donation for kidney transplants (LDKT). We previously theorized that an enhanced recovery after surgery (ERAS) pathway for LDKT will reduce perioperative narcotic use. The aim of this post hoc analysis of merged data from two ERAS trials was to review the one-year follow-up to determine if the exposure to ketorolac versus placebo had any significant impact on long-term kidney function after LDKT. Methods One-year post hoc analysis of merged data from two ERAS LDKT, prospective, double-blind, randomized clinical trials were combined involving a total of 72 patients undergoing nephrectomy for LDKT. Kidney functions of both the ERAS groups' versus placebo were compared prospectively and blinded at one year using estimated glomerular filtration rate (eGFR) and total protein (TP) in the urine in compliance with United Network for Organ Sharing (UNOS) live donor requirements. Results There was no significant difference in postoperative eGFR at one year between ERAS and placebo groups. TP urine at one-year post-operative was significantly lower in the ERAS cohort by 4.7 mg/dl (95% CI 0.48 ~ 8.82, p = 0.025). Conclusions The ERAS groups' exposure to ketorolac did not negatively affect kidney function at one year after LDKT.
背景与目的 肾移植活体供肾（LDKT）术后阿片类药物的使用情况备受关注。我们之前推测，LDKT的术后加速康复（ERAS）方案将减少围手术期麻醉药物的使用。本项对两项ERAS试验合并数据的事后分析旨在回顾一年随访情况，以确定酮咯酸与安慰剂的使用对LDKT术后长期肾功能是否有显著影响。方法 对两项ERAS LDKT前瞻性、双盲、随机临床试验的合并数据进行一年的事后分析，共有72例接受LDKT肾切除术的患者纳入研究。根据器官共享联合网络（UNOS）活体供肾要求，前瞻性地比较ERAS组与安慰剂组在一年时的肾功能，并采用估计肾小球滤过率（eGFR）和尿总蛋白（TP）进行盲法评估。结果 ERAS组与安慰剂组在术后一年时的eGFR无显著差异。ERAS队列术后一年时的尿TP显著降低4.7mg/dl（95%CI 0.48~8.82，p=0.025）。结论 ERAS组使用酮咯酸对LDKT术后一年的肾功能无负面影响。
