Feasibility, Safety and Efficacy of Enhanced Recovery after Living Donor Nephrectomy: Systematic Review and Meta-Analysis of Randomized Controlled Trials

This meta-analysis aims to compare enhanced recovery after surgery (ERAS) vs. standard perioperative practice in the management of living kidney donors. Primary endpoints included mortality, complications, length of stay (LOS) and quality of life after living donor nephrectomy. Medline, Embase, Scopus, Cochrane and Web of Science databases were searched. In total, 3029 records were identified. We then screened 114 full texts. Finally, 11 studies were included in the systematic review corresponding to 813 living donors. Of these, four randomized controlled trials were included in the meta-analysis. ERAS resulted in shorter LOS (95CI: −1.144, −0.078, I(2) = 87.622%) and lower incidence of post-operative complications (95CI: 0.158, 0.582, I(2) = 0%). This referred to Clavien–Dindo I-II complications (95CI: 0.158, 0.582, I(2) = 0%). There was no difference in Clavien–Dindo III-V complications (95CI: 0.061,16.173, I(2) = 0%). ERAS donors consumed decreased amounts of narcotics during their hospital stay (95CI: −27.694, −8.605, I(2) = 0%). They had less bodily pain (95CI: 6.735, 17.07, I(2) = 0%) and improved emotional status (95CI: 6.593,13.319, I(2) = 75.682%) one month postoperatively. ERAS protocols incorporating multimodal pain control interventions resulted in a mean reduction of 1 day in donors’ LOS (95CI: −1.374, −0.763, I2 = 0%). Our results suggest that ERAS protocols result in reduced perioperative morbidity, shorter length of hospital stay and improved quality of life after living donor nephrectomy.