The application of enhanced recovery after surgery in kidney transplantation recipients during perioperative managemant

Objective To explore the validity and security of enhanced recovery after surgery (ERAS) in kidney transplantation recipients during perioperative managemant. Methods The clinical data of 474 kidney transplantation recipients who received kidney transplantation in Kidney Disease Center, the First Affiliated Hospital, School of Medicine, Zhejiang University during July 2016 to August 2017 were retrospectively analysed, among which 315 recipients who got traditional perioperative managemant during July 2016 to April 2017 were divided into traditional group, and 159 recipients who got ERAS during perioperative managemant were diveded into ERAS group. The main content of ERAS included bowel preparation removal, preoperative carbohydrate loading, early-stage feeding, early mobilization, multimodal approach to opioid-sparing pain control and so on. Indexes like mean post operation hospitalization duration, serum creatinine, gastrointestinal reaction, delayed graft dysfunction (DGF), acute reaction during 90 days after surgery, incidence rate of new-onset diabetes mellitus after transplantation and unscheduled readmission rate during 90 days after surgery were compared between the 2 groups. Measurement data like age, weight and time of dialysis preoperative between the 2 groups were compared by Student′s t-test, and enumeration data like incidence rate of DGF and acute reaction during 90 days after surgery between the 2 groups were compared by chi-square test. Results No statistical difference was found in gender, age, height, weight, time of dialysis preoperative, type of donor kidney and HLA mismatch number between the 2 groups (P all >0.05). The post operation hospitalization duration of living donor renal transplantation recipients and cadaveric donor renal transplantation recipients in ERAS group were (7.7±2.0) d and (12.8±8.3) d, respectively, which were shorter than traditional group [(9.0±3.8) d and (16.7±12.6) d], and the difference was statistically significant (t=-2.594 and -2.692, P all 0.05). The incidence rate of diarrhea of ERAS group and traditional group were 5.7% (9/159) and 20.7% (65/315), respectively, which had statistical difference (χ2=18.092, P 0.05). Conclusions ERAS protocol can decreased post operation hospitalization duration and incidence rate of diarrhea without influence on other complications, which was safe and effective. Key words: Enhanced recovery after surgery; Kidney transplantation; Perioperative management