A national survey on enhanced recovery for renal transplant recipients: current practices and trends in the UK

Abstract

Introduction Enhanced recovery after surgery (ERAS) is well established in many specialties but has not been widely adopted in renal transplantation. The aim of this survey was to understand current national practices and sentiment concerning ERAS for renal transplant recipients in the UK. Methodology A national web-based survey was sent to consultant surgeons at all 23 UK adult renal transplant units. Completed questionnaires were collected between May and July 2020. Data were analysed according to individual responses and grouped according to the existence of formal ERAS pathways within units. Results All transplant units were represented in this survey. Three units had a formal ERAS pathway for all recipients. Of the remaining units, 65.9% considered implementing an ERAS pathway in the near future. The most commonly perceived barrier to ERAS implementation was ‘embedded culture within transplant units’ (54.8% of respondents). A fifth of respondents insert surgical drains selectively and 11.7% routinely discontinue patient-controlled analgesia on postoperative day 1. Most respondents routinely remove urinary catheters on day 5 (70%) and ureteric stents 4–6 weeks post-transplantation (81.7%). Median length of stay for deceased donor kidney transplant recipients was lower in units with ERAS programmes (5–7 days versus 8–10 days, respectively). The main cited barriers for discharge were ‘suboptimal fluid balance’ and ‘requirement of treatment for rejection’. Conclusions Despite slow uptake of ERAS in kidney transplantation, appetite appears to be increasing, particularly in the post-COVID-19 era. The current practice and opinions of transplant specialists highlighted in this survey may help to establish nationally agreed ERAS guidelines in this field.

Response to Should sleeve gastrectomy be a preoperative standard in kidney transplant waitlisted patients with a BMI of 35 kg/m2

“…As bariatric surgery remains the only sustainable treatment option for morbid obesity, we believe kidney transplant candidates with a BMI of ≥ 35 kg/m 2 should be evaluated for obesity treatment involving bariatric surgery early in the disease. Additionally, prehabilitation and ERAS (enhanced recovery after surgery) programs are becoming more important not only in bariatric surgery but also in kidney transplant candidates and should be implemented in the preparation process to achieve sustainable outcomes [7,8]. In the coming years, the rate of marginal organs will remain high, and the scarcity of donor organs will prevail.…”