Eltemamy Mohamed, Oh Paul J, Siddiqui Hafiz Umair, Lin Yi-Chia, Lansang M Cecilia, Poggio Emilio, Goldfarb David, Krishnamurthi Venkatesh, Wee Alvin
Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Urology Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt.
Clin Transplant. 2025 Jan;39(1):e70056. doi: 10.1111/ctr.70056.
Enhanced recovery after surgery (ERAS) protocols have gained widespread acceptance as a means to enhance surgical outcomes. However, the intricate care required for kidney transplant recipients has not yet led to the establishment of a universally recognized and dependable ERAS protocol for kidney transplantation.
We devised a customized ERAS protocol to determine its effectiveness in improving surgical and postoperative outcomes among kidney transplant recipients.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective, single-center study performed at our tertiary care institution. Three hundred and fifty-six patients in the conventional group (from January 1, 2015 to December 31, 2017) and 442 patients from the ERAS group (from January 1, 2018 to June 1, 2020) were compared. Patients were followed for 1 year postoperatively.
Changes were made in the preoperative, operative, postoperative, and outpatient follow-up settings after transplantation.
Primary endpoints were hospital length of stay (LOS) and 30-day readmission rates. We also measured surgical outcomes, graft performance, and patient survival. Wilcoxon rank-sum, Pearson's Chi-squared, or Fisher's exact tests were used to compare groups.
Our ERAS protocol was associated with a decrease in hospital LOS from 5 to 3 days (p < 0.001) and 57.1% lower odds of hospital readmissions within 30 days compared to the conventional group (p < 0.001, 95% CI 0.26-0.7). Decreases in operative estimated blood loss, blood transfusion rates, and delayed graft function were also associated with the ERAS protocol.
Our multi-layered ERAS protocol is effective in improving outcomes for kidney transplant recipients. A future multi-institutional study with healthcare savings analysis may suggest that widespread benefits are yet to be realized by the greater implementation of such enhanced recovery protocols.
术后加速康复（ERAS）方案已作为一种改善手术效果的方法而得到广泛认可。然而，肾移植受者所需的复杂护理尚未促成建立一个普遍认可且可靠的肾移植ERAS方案。
我们设计了一个定制的ERAS方案，以确定其在改善肾移植受者手术及术后效果方面的有效性。
设计、设置和参与者：这是一项在我们三级医疗机构进行的回顾性单中心研究。比较了常规组的356例患者（2015年1月1日至2017年12月31日）和ERAS组的442例患者（2018年1月1日至2020年6月1日）。患者术后随访1年。
在移植后的术前、术中、术后及门诊随访环节做出了改变。
主要终点为住院时间（LOS）和30天再入院率。我们还测量了手术效果、移植物功能和患者生存率。采用Wilcoxon秩和检验、Pearson卡方检验或Fisher精确检验进行组间比较。
我们的ERAS方案与住院LOS从5天降至3天相关（p < 0.001），与常规组相比，30天内再次入院的几率降低了57.1%（p < 0.001，95%CI 0.26 - 0.7）。手术估计失血量、输血率和移植肾功能延迟的降低也与ERAS方案相关。
我们的多层ERAS方案在改善肾移植受者的治疗效果方面是有效的。未来一项包含医疗费用节省分析的多机构研究可能表明，更广泛地实施此类加速康复方案的广泛益处尚未实现。
