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The Enhanced Recovery after Surgery (ERAS) Pathway Is a Safe Journey for Kidney Transplant Recipients during the “Extended Criteria Donor” Era
Enhanced recovery after surgery (ERAS) protocols are still underused in kidney transplantation (KT) due to recipients’ “frailty” and risk of postoperative complications. We aimed to evaluate the feasibility and safety of ERAS in KT during the “extended-criteria donor” era, and to identify the predic...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9610733/ https://www.ncbi.nlm.nih.gov/pubmed/36297249 http://dx.doi.org/10.3390/pathogens11101193 |
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author | Angelico, Roberta Romano, Francesca Riccetti, Camilla Pellicciaro, Marco Toti, Luca Favi, Evaldo Cacciola, Roberto Manzia, Tommaso Maria Tisone, Giuseppe |
author_facet | Angelico, Roberta Romano, Francesca Riccetti, Camilla Pellicciaro, Marco Toti, Luca Favi, Evaldo Cacciola, Roberto Manzia, Tommaso Maria Tisone, Giuseppe |
author_sort | Angelico, Roberta |
collection | PubMed |
description | Enhanced recovery after surgery (ERAS) protocols are still underused in kidney transplantation (KT) due to recipients’ “frailty” and risk of postoperative complications. We aimed to evaluate the feasibility and safety of ERAS in KT during the “extended-criteria donor” era, and to identify the predictive factors of prolonged hospitalization. In 2010–2019, all patients receiving KT were included in ERAS program targeting a discharge home within 5 days of surgery. Recipient, transplant, and outcomes data were analyzed. Of 454 KT [male: 280, 63.9%; age: 57 (19–77) years], 212 (46.7%) recipients were discharged within the ERAS target (≤5 days), while 242 (53.3%) were discharged later. Patients within the ERAS target (≤5 days) had comparable recipient and transplant characteristics to those with longer hospital stays, and they had similar post-operative complications, readmission rates, and 5 year graft/patient survival. In the multivariate analysis, DGF (HR: 2.16, 95% CI: 1.08–4.34, p < 0.030) and in-hospital dialysis (HR: 3.68, 95% CI: 1.73–7.85, p < 0.001) were the only predictive factors for late discharge. The ERAS approach is feasible and safe in all KT candidates, and its failure is primarily related to the postoperative graft function, rather than the recipient’s clinical status. ERAS pathways, integrated with strict collaboration with local nephrologists, allow early discharge after KT, with clinical benefits. |
format | Online Article Text |
id | pubmed-9610733 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-96107332022-10-28 The Enhanced Recovery after Surgery (ERAS) Pathway Is a Safe Journey for Kidney Transplant Recipients during the “Extended Criteria Donor” Era Angelico, Roberta Romano, Francesca Riccetti, Camilla Pellicciaro, Marco Toti, Luca Favi, Evaldo Cacciola, Roberto Manzia, Tommaso Maria Tisone, Giuseppe Pathogens Article Enhanced recovery after surgery (ERAS) protocols are still underused in kidney transplantation (KT) due to recipients’ “frailty” and risk of postoperative complications. We aimed to evaluate the feasibility and safety of ERAS in KT during the “extended-criteria donor” era, and to identify the predictive factors of prolonged hospitalization. In 2010–2019, all patients receiving KT were included in ERAS program targeting a discharge home within 5 days of surgery. Recipient, transplant, and outcomes data were analyzed. Of 454 KT [male: 280, 63.9%; age: 57 (19–77) years], 212 (46.7%) recipients were discharged within the ERAS target (≤5 days), while 242 (53.3%) were discharged later. Patients within the ERAS target (≤5 days) had comparable recipient and transplant characteristics to those with longer hospital stays, and they had similar post-operative complications, readmission rates, and 5 year graft/patient survival. In the multivariate analysis, DGF (HR: 2.16, 95% CI: 1.08–4.34, p < 0.030) and in-hospital dialysis (HR: 3.68, 95% CI: 1.73–7.85, p < 0.001) were the only predictive factors for late discharge. The ERAS approach is feasible and safe in all KT candidates, and its failure is primarily related to the postoperative graft function, rather than the recipient’s clinical status. ERAS pathways, integrated with strict collaboration with local nephrologists, allow early discharge after KT, with clinical benefits. MDPI 2022-10-16 /pmc/articles/PMC9610733/ /pubmed/36297249 http://dx.doi.org/10.3390/pathogens11101193 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Angelico, Roberta Romano, Francesca Riccetti, Camilla Pellicciaro, Marco Toti, Luca Favi, Evaldo Cacciola, Roberto Manzia, Tommaso Maria Tisone, Giuseppe The Enhanced Recovery after Surgery (ERAS) Pathway Is a Safe Journey for Kidney Transplant Recipients during the “Extended Criteria Donor” Era |
title | The Enhanced Recovery after Surgery (ERAS) Pathway Is a Safe Journey for Kidney Transplant Recipients during the “Extended Criteria Donor” Era |
title_full | The Enhanced Recovery after Surgery (ERAS) Pathway Is a Safe Journey for Kidney Transplant Recipients during the “Extended Criteria Donor” Era |
title_fullStr | The Enhanced Recovery after Surgery (ERAS) Pathway Is a Safe Journey for Kidney Transplant Recipients during the “Extended Criteria Donor” Era |
title_full_unstemmed | The Enhanced Recovery after Surgery (ERAS) Pathway Is a Safe Journey for Kidney Transplant Recipients during the “Extended Criteria Donor” Era |
title_short | The Enhanced Recovery after Surgery (ERAS) Pathway Is a Safe Journey for Kidney Transplant Recipients during the “Extended Criteria Donor” Era |
title_sort | enhanced recovery after surgery (eras) pathway is a safe journey for kidney transplant recipients during the “extended criteria donor” era |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9610733/ https://www.ncbi.nlm.nih.gov/pubmed/36297249 http://dx.doi.org/10.3390/pathogens11101193 |
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