Systematic review and meta-analysis of outcomes following ERAS in kidney transplantation

Introduction : Enhanced Recovery After Surgery (ERAS) protocols have gained widespread acceptance to improve surgical outcomes. However, in kidney transplantation, standardized practice has not yet been universally established. The aim of the present meta-analysis is to evidence the current state of ERAS in the kidney transplant population. Patients and Methods : A systematic search was conducted through Medline, Embase, Cochrane, Scopus, Web of Science, ClinicalTrials.gov. databases. A total of 31 studies were initially identified of which 9 finally met the inclusion criteria. Risk of bias assessment and meta-analysis were then performed. Outcomes of interest consisted of length of hospital stay (LOS), delayed graft function (DGF), complications and readmission rates within 30-days from surgery. Results : A total of 2242 kidney transplant recipients were included in the meta-analysis, of which 1179 underwent ERAS interventions. LOS was found to be shorter in recipients undergoing ERAS protocols. A non-significant trend toward reduced postoperative complications was observed (RR 0.86, 95% CI 0.62–1.19). Hospital readmissions showed no significant difference between groups. DGF incidence remained uncertain and non-significant. Conclusions : ERAS protocols in kidney transplantation appear feasible and have been implemented in a limited number of centres. The evidence base is heterogeneous and poorly reported to establish effectiveness in improving post kidney transplant function.