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.
Highlights
Living donor renal transplantation (LDRT) is the optimal form of renal replacement therapy (RRT) for suitable patients with end stage renal disease (ESRD)
Despite the low risks for donors, the benefits to recipients and to society at large, the rates of LDRT remain low compared to dialysis therapy and deceased donor renal transplant (DDRT), internationally
We aim to summarize the different preoperative, intraoperative and postoperative enhanced recovery after surgery (ERAS) interventions and streamline them in order to fulfil the need for one state-of-the-art ERAS protocol for living donor nephrectomy (LDN)
Summary
Living donor renal transplantation (LDRT) is the optimal form of renal replacement therapy (RRT) for suitable patients with end stage renal disease (ESRD). When compared to the alternative of dialysis therapy, either as hemodialysis or peritoneal dialysis, it is associated with substantial improvement in quality of life (QoL), reduced mortality and morbidity and increased cost-effectiveness [1]. Living kidney donation is not associated with significant long-term health risks. O’Keeffe et al, in their 2018 meta-analysis published in Annals of Internal Medicine, found that, apart from a low absolute risk for future development of ESRD (1 case per 1000 personyears) and pregnancy complications, living kidney donors have no increased risk for other major chronic diseases, long-term morbidity and mortality [4]. Despite the low risks for donors, the benefits to recipients and to society at large, the rates of LDRT remain low compared to dialysis therapy and DDRT, internationally. In 2019 across Europe, only 9.94 LDRTs per million population (pmp) were performed [5]
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