Romano Francesca, Angelico Roberta, Toti Luca, Orsi Michela, Marsella Valentina Enrica, Manzia Tommaso Maria, Emberti Gialloreti Leonardo, Tisone Giuseppe
HPB and Transplant Unit, Department of Surgical Sciences, University of Rome Tor Vergata, 00133 Rome, Italy.
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy.
J Clin Med. 2025 Mar 31;14(7):2387. doi: 10.3390/jcm14072387.
Enhanced recovery after surgery (ERAS) pathways are still underutilized in kidney transplantation (KT), and their feasibility after delayed graft function (DGF) is unknown. We aimed to evaluate safety and cost savings after ERAS implementation in KT recipients with DGF. A retrospective analysis of KT recipients enrolled in the ERAS program with DGF (≥1 dialytic treatment during the first postoperative week or creatinine≥ 2.5 mg/dL on postoperative day 10) between 2010 and 2019 was performed. Recipient, donor, and transplant data, outcomes, and 1-year post-KT costs were collected, comparing recipients within the ERAS target (≤5 days, "early discharge group") to those discharged later (>5 days, "late discharge group"). Out of 170 KT recipients with DGF, 33 (19.4%) were in the "early discharge group" and 137 (80.5%) in the "late discharge group". Recipient, donor, and transplant characteristics were similar in the two groups. The length of hospital stay (LOS) of the "early discharge group" was significantly shorter, with fewer in-hospital dialysis sessions ( < 0.001) compared to the "late discharge group". One year post-KT, no significant differences were observed in postoperative complications, readmissions, or number of outpatient visits. Five-year graft and patient survival along with five-year graft function were similar between the two cohorts. First-year costs were significantly higher in the "late discharge group" ( < 0.001), with a median excess cost (Δ) of EUR 4515.76/patient. Factors influencing first-year costs post-KT were LOS for KT, recipient age, and use of expanded-criteria grafts. The ERAS approach is safe in KT recipients with DGF and allows for economic savings, while its implementation does not cause worse clinical outcomes in recipients.
术后加速康复（ERAS）方案在肾移植（KT）中仍未得到充分利用，且其在移植肾功能延迟（DGF）后的可行性尚不清楚。我们旨在评估在患有DGF的KT受者中实施ERAS后的安全性和成本节约情况。对2010年至2019年间纳入ERAS项目且患有DGF（术后第一周内≥1次透析治疗或术后第10天肌酐≥2.5mg/dL）的KT受者进行了回顾性分析。收集了受者、供者和移植数据、结局以及KT术后1年的成本，将ERAS目标范围内（≤5天，“早期出院组”）的受者与出院较晚（>5天，“晚期出院组”）的受者进行比较。在170例患有DGF的KT受者中，33例（19.4%）属于“早期出院组”，137例（80.5%）属于“晚期出院组”。两组的受者、供者和移植特征相似。与“晚期出院组”相比，“早期出院组”的住院时间（LOS）明显更短，住院透析次数更少（<0.001）。KT术后1年，术后并发症、再入院率或门诊就诊次数方面未观察到显著差异。两组之间的5年移植物和患者生存率以及5年移植物功能相似。“晚期出院组”的第一年成本显著更高（<0.001），每位患者的中位额外成本（Δ）为4515.76欧元。影响KT术后第一年成本的因素包括KT的LOS、受者年龄和扩大标准供肾的使用。ERAS方法在患有DGF的KT受者中是安全的，并可实现成本节约，同时其实施不会导致受者出现更差的临床结局。
