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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...

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Autores principales: Angelico, Roberta, Romano, Francesca, Riccetti, Camilla, Pellicciaro, Marco, Toti, Luca, Favi, Evaldo, Cacciola, Roberto, Manzia, Tommaso Maria, Tisone, Giuseppe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
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.
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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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