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CHALLENGING THE OLD TRADITIONS IN RENAL TRANSPLANTATION: THE
FIRST UK ENHANCED RECOVERY AFTER RENAL TRANSPLANTATION
Halawa, A, Gray, C, Rowe, S, Plant, M, Hanvere, J, Abbas, G, Boyes, S, Nathan, C,
Roberts, F
Sheffield Kidney Institute Sheffield Teaching Hospitals
INTRODUCTION: Traditional management of postoperative pain and management of
urinary catheter, lines and drains led to longer hospital stay and subsequent delayed recovery.
There has been anxiety among renal transplant surgeons and physicians that enhanced
recovery principles cannot be applied to these immunocompromised patients who are ASA
III.
AIM: To apply the principle of enhanced recovery programme in renal transplant recipients
and assess the changes in the quality of patients’ care.
METHODS: Patient education and discharge planning are commenced on admission.
Intraoperative management including goal-directed fluid management using
Transoesophageal Doppler was also implemented to achieve adequate fluid balance and avoid
central lines. Intrathecal diamorphine and transverses abdominis plane block (TAP block)
were used to minimise the use of systemic morphine (PCA) to achieve improved
postoperative analgesia. Patients were commenced oral intake few hours after the operation.
Urinary catheters were removed 4 days after the operation. This enabled early mobilisation
and patient education resulting early discharge without increase in the readmission rate.
RESULTS: Postoperative PCA requirement was significantly reduced in ER patients
compared to standard recovery patients (P<0.001) demonstrating better postoperative
analgesia. The length of stay was significantly reduced (P<0.001) for living transplant
recipients (Mean 5.2 vs. 9.4 days, Median 5 vs. 9 days) and for deceased donor transplant
recipients (Mean 5.2 vs. 11.5 days, Median 5 vs. 8.5 days) compared to patients who had
traditional recovery. There is significant correlation between LOS and morphine requirement
(r = 0.55, P <0.001). Implementing ER saves 2160 pounds per patients (533 pounds per day).
CONCLUSION: Our study demonstrates that ER benefits both forms of renal transplantation
with better quality of care and no difference in LOS.