Application of Enhanced Recovery After Surgery in Patients Undergoing Kidney Transplant: the Belfast Protocol

O’Neill, Stephen; McGrogan, Damian; Sweeney, Niamh; McDaid, James; Beckett, Neal; Magowan, Hannah; McCaughan, Jennifer; Courtney, Aisling E.; Brown, Tim

doi:10.1016/j.transproceed.2021.07.046

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…We suggest that a change in practice should not be delayed while waiting for a large RCT but that, instead, transplant clinicians should initiate a stepwise reduction in unnecessary cardiac screening, accompanied by careful contemporaneous auditing [30].…”

Section: Discussionmentioning

confidence: 99%

“…Patients presenting for transplantation on beta blockers have these medications continued during the perioperative phase to reduce the risk of rebound tachycardia [29]. Furthermore, our enhanced surgical recovery protocol minimises fluid administration (and potential overload) compared to the fluid prescription practices described in other centres [30,31].…”

Section: Limitationsmentioning

confidence: 99%

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The Minimisation of Cardiovascular Disease Screening for Kidney Transplant Candidates

Corr,

Orr,

Courtney

2024

JCM

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Background: There is increasing evidence that cardiac screening prior to kidney transplantation does not improve its outcomes. However, risk aversion to perioperative events means that, in practice, testing remains common, limiting the availability of ‘real-world’ data to support any change. Our objective was to assess perioperative and 1-year post-transplant cardiovascular events in a kidney transplant candidate cohort who received minimal cardiovascular screening. Methods: The retrospective cohort study included all adult kidney-only transplant recipients in a single UK region between January 2015 and December 2021. Kidney transplant recipients asymptomatic of cardiac disease, even those with established risk factors, did not receive cardiac stress testing. The perioperative and 1-year post-transplant cardiovascular event incidences were examined. Logistic regression was used to identify variables of statistical significance that predicted cardiovascular or cerebrovascular events. Results: A total of 895 recipients fulfilled the inclusion criteria. Prior to transplantation, 209 (23%) recipients had an established cardiac diagnosis, and 193 (22%) individuals had a diagnosis of diabetes. A total of 18 (2%) patients had a perioperative event, and there was a 5.7% incidence of cardiovascular events 1 year post-transplantation. The cardiovascular mortality rate was 0.0% perioperatively, 0.2% at 3 months post-transplant, and 0.2% at 1 year post-transplant. Conclusions: This study demonstrates comparable rates of cardiovascular events despite reduced screening in asymptomatic recipients. It included higher risk individuals who may, on the basis of screening results, have been excluded from transplantation in other programmes. It provides further evidence that extensive cardiac screening prior to kidney transplantation is unlikely to be offset by reduced rates of cardiovascular events.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

The Minimisation of Cardiovascular Disease Screening for Kidney Transplant Candidates

Corr,

Orr,

Courtney

2024

JCM

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“…Research should also be dedicated to understanding why there are such stark differences in the LOS between different geographic regions in the United States, how these may be decreased, and whether they are related to procedural, population, or other differences between speci c high performing and low performing transplant centers. Finally, research into the implementation of enhanced recovery after surgery (ERAS) methods should be explored following pediatric KT, as various studies have shown its effectiveness in reducing LOS in the adult population [32][33][34][35][36].…”

Section: Discussionmentioning

confidence: 99%

A novel risk score for predicting prolonged length of stay following pediatric kidney transplant

et al. 2023

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BackgroundKidney transplants (KT) are accepted as the kidney replacement therapy of choice for children with kidney failure. The surgery itself may be more di cult especially in small children, and often leads to signi cant hospital stays. There is little research for predicting prolonged length of stay (LOS) in children. We aim to examine the factors associated with prolonged LOS following pediatric KT to help clinicians make informed decisions, better counsel families, and potentially reduce preventable causes of prolonged stay. MethodsWe retrospectively analyzed the United Network for Organ Sharing database for all KT recipients less than 18-years-old between January 2014 and July 2022 (n = 3,693). Donor and recipient factors were tested in univariate and multivariate logistic analysis using stepwise elimination of non-signi cant factors to create a nal regression model predicting LOS longer than 14 days. Values were assigned to signi cant factors to create risk scores for each individual patient. ResultsIn the nal model, only primary diagnosis of focal segmental glomerulosclerosis, dialysis prior to KT, geographic region, and recipient weight prior to KT were signi cant predictors of LOS longer than 14 days. The C-statistic of the model is 0.7308. The C-statistic of the risk score is 0.7221. ConclusionsKnowledge of the risk factors affecting prolonged LOS following pediatric KT can help identify patients at risk of increased resource use and potential hospital-acquired complications. Using our index, we identi ed some of these speci c risk factors and created a risk score that can stratify pediatric recipients into low, medium, or high-risk groups.

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Enhanced recovery after surgery recommendations for renal transplantation: guidelines

Tan

Bhatia

Sharma

et al. 2022

British Journal of Surgery

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Background Enhanced Recovery After Surgery (ERAS) protocols are now widely practiced in major surgery, improving postsurgical outcomes. Uptake of these programmes have been slow in kidney transplantation due to challenges in evaluating their safety and efficacy in this high-risk cohort. To date, there are no unified guidance and protocols specific to ERAS in kidney transplantation surgery. This paper aims to summarise current evidence in the literature and develop ERAS protocol recommendations for kidney transplantation recipients. Methods PubMed, Cochrane, Embase and Medline databases were screened for studies relevant to ERAS protocols in kidney transplantation, up to August 2021. A secondary search was repeated for each ERAS recommendation to explore the specific evidence base available for each section of the protocol. Randomised controlled trials, case-control and cohort studies were included. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework was used to evaluate the quality of evidence available and recommendations. Results We identified six eligible studies with a total of 1225 participants. All studies found a reduction in length of hospital stay without affecting readmission rates. The evidence behind specific pre-operative, intra-operative and post-operative interventions included in current ERAS protocols are reviewed and discussed. Conclusion Compared to other surgical specialties, the evidence base for ERAS in kidney transplantation remains lacking, with further room for research and development. However, significant improvements to patient outcomes are already possible with application of the currently available evidence. This has shown that ERAS in kidney transplantation surgery is safe and feasible, with improved postoperative outcomes.

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Application of Enhanced Recovery After Surgery in Patients Undergoing Kidney Transplant: the Belfast Protocol

Cited by 4 publications

References 4 publications

The Minimisation of Cardiovascular Disease Screening for Kidney Transplant Candidates

The Minimisation of Cardiovascular Disease Screening for Kidney Transplant Candidates

A novel risk score for predicting prolonged length of stay following pediatric kidney transplant

Enhanced recovery after surgery recommendations for renal transplantation: guidelines

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