Donor difference is an important factor to accelerate the implementation of enhanced recovery after surgery (ERAS) in renal transplantation
Tian Puxun1, Wang Yuxiang1, Dou Meng1, Zheng Bingxuan1, Deng Ge1, Wang Qiang1, Ding Chenguang1, Ding Xiaoming1, Xue Wujun1.
1Department of Kidney Transplantation, Hospital of Nephropathy, First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi'an, People's Republic of China
Objective: To explore the efficacy and safety of ERAS in DD (deceased donation) with kidney transplantation during perioperative management.
Methods: The clinical data of 534 cases of allograft renal transplantation recipients from October 2016 to March 2019 operated in Xi'an Jiaotong university medical school first affiliated hospital kidney disease were retrospectively analyzed. From October 2016 to March 2018, the implementation of traditional perioperative management of 365 cases of recipients were selected for the traditional group. From March 2018 to March 2019, the implementation of ERAS scheme were selected for ERAS group, 169 cases of recipients. The management of EARS group mainly includes two parts: the maintenance of donor; The second is the ERAS perioperative management of the patient. The first part includes the acquisition of preoperative use of human albumin 20g, preoperative use of teicoplanin+ daptomycin + caspofungin 6-12h comprehensive anti-infection, rational use of blood pressure booster, accurate maintenance of systolic blood pressure at 110-140 mmHg, and Lifepot continuous in vitro hypothermia perfusion; The second part includes the elimination of intestinal preparation, preoperative carbohydrate intake, early feeding, early activity, and multi-mode analgesia. Mean postoperative hospital stay, serum creatinine levels, gastrointestinal reactions, delayed graft function recovery (DGF), and other postoperative complications were observed and compared between the two groups.
Results: There were no statistically significant differences in gender, age, height, body mass, preoperative dialysis time, donor kidney type, and HLA mismatch between ERAS group and traditional group (P all >0.05).The postoperative hospital stay of DD kidney graft recipients in ERAS group was (13.8±4.2)d, shorter than that in the traditional group (18.4±5.2)d, with statistically significant difference (t=10.08, P<0.05). VAS score of ERAS group was (3.5±0.5), smaller than that of the traditional group (4.5±0.9), and the difference was statistically significant (t=13.51, P<0.05). After applying the extension of ERAS concept, the mean hospital stay of recipients with and without DGF was (15.6±5.2) d and (14.1±4.5) d, respectively, which were shorter than the mean hospital stay of patients in the traditional group (23.2±8.5) d and (18.3±6.1) d.
Conclusions: It is effective and safe to apply ERAS to perioperative management of kidney transplantation, which can reduce the average postoperative hospital stay of recipients and reduce postoperative pain and satisfaction enhancement without increasing the occurrence of other complications. Moreover, "donor maintenance" + ERAS (Extension of ERAS) is applied to high-risk donors in DD to achieve more significant results.
Keywords: ERAS；High-risk Donors； Kidney Transplantation ; Perioperative management
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