Enhanced recovery after surgery recommendations for renal transplantation: guidelines

Abstract

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.

Risk assessment of organ transplant operation: A fuzzy hybrid MCDM approach based on fuzzy FMEA

“…Recently, a study aimed to improve the recovery process following major surgical procedures, with a specific focus on renal transplantation. The objective was to consolidate existing evidence from the literature and formulate recommendations for an enhanced recovery after surgery protocol tailored specifically for individuals undergoing renal transplant procedures [ 57 ]. Detailed information about the reviewed studies can be found in Table 1 .…”

A Transplant-Inclusive Value-Based Kidney Care Payment Model

“… 44 A recent meta-analysis of early recovery after surgery protocols in kidney transplantation showed a paucity of well-designed published trials, but generally associated early recovery after surgery implementation with reductions in hospital LOS without increases in rates of readmission. 45 …”

Nutritional Risk of Candidates for Simultaneous Pancreatic–Kidney Transplantation—A Narrative Review

“…Early enteral nutrition, described as an enteral feed initiated within 24 h of surgery, is one of the main parts of enhanced recovery after surgery (ERAS) protocols in abdominal surgery, regarding, for example, esophageal, gastric, pancreatic, or bowel surgery [96][97][98][99]. Some protocols for liver and renal transplantation also exist [100,101]. ERAS protocols in post-pancreatic transplantation surgery are yet to be established [102].…”