Feasibility, Safety and Efficacy of Enhanced Recovery after Living Donor Nephrectomy: Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

This meta-analysis aims to compare enhanced recovery after surgery (ERAS) vs. standard perioperative practice in the management of living kidney donors. Primary endpoints included mortality, complications, length of stay (LOS) and quality of life after living donor nephrectomy. Medline, Embase, Scopus, Cochrane and Web of Science databases were searched. In total, 3029 records were identified. We then screened 114 full texts. Finally, 11 studies were included in the systematic review corresponding to 813 living donors. Of these, four randomized controlled trials were included in the meta-analysis. ERAS resulted in shorter LOS (95CI: −1.144, −0.078, I2 = 87.622%) and lower incidence of post-operative complications (95CI: 0.158, 0.582, I2 = 0%). This referred to Clavien–Dindo I-II complications (95CI: 0.158, 0.582, I2 = 0%). There was no difference in Clavien–Dindo III-V complications (95CI: 0.061,16.173, I2 = 0%). ERAS donors consumed decreased amounts of narcotics during their hospital stay (95CI: −27.694, −8.605, I2 = 0%). They had less bodily pain (95CI: 6.735, 17.07, I2 = 0%) and improved emotional status (95CI: 6.593,13.319, I2 = 75.682%) one month postoperatively. ERAS protocols incorporating multimodal pain control interventions resulted in a mean reduction of 1 day in donors’ LOS (95CI: −1.374, −0.763, I2 = 0%). Our results suggest that ERAS protocols result in reduced perioperative morbidity, shorter length of hospital stay and improved quality of life after living donor nephrectomy.

Enhanced Recovery after Renal Transplantation Decreases Recipients’ Urological Complications and Hospital Stay: A Systematic Review and Meta-Analysis

“…This protocol followed the same principles (preoperative carbohydrate loading, placement of wound infiltration catheters, early mobilization and enteral nutrition postoperatively, etc.) as the living donors’ ERAS protocol published by our team earlier this year that was also shown to decrease patients’ length of stay and complications [ 21 ]. There were two important alterations though, namely the placement of a double JJ stent intraoperatively and the removal of this stent in the early post-operative period (POD7-POD21).…”

Anaesthetic Approach to Enhanced Recovery after Surgery for Kidney Transplantation: A Narrative Review

“…In ERAS protocols for kidney transplantation, catheters providing analgesia were removed before day 2, where day 0 is the day of the surgery [ 3 , 5 ].…”

“…The ERAS Society consensus guidelines have been developed in multiple specialties, but there is no review on ERAS programs for kidney transplant recipients. Some authors have reported on the development of their own ERAS pathway [ 3 ], and on the successful implementation of the ERAS program in kidney transplants (KTx) that show a significant reduction in the length of hospital stays (LoS) and costs, with no increase in the frequency of complications [ 4 , 5 , 6 ].…”

Is Laparoscopic Technique Suitable for Initial Experience in Live Donor Nephrectomy? Results of The First 51 Cases

“…With the development of technology, the widespread use of the technique and the increase in experience, it has been shown by randomized controlled studies and meta-analyzes that the results of minimally invasive methods are similar to the open method and that these fears are unfounded [19][20][21]. In addition early meta analysis of randomized controlled trials shown that with enhanced recovery after surgery (ERAS) protocols living donor nephrectomy is feasible and safety [22].…”