Abstract
Background and ObjectiveOpioid exposure is a concern after live donation for kidney transplants (LDKT). We previously theorized that an enhanced recovery after surgery (ERAS) pathway for LDKT will reduce perioperative narcotic use. The aim of this post hoc analysis of merged data from two ERAS trials was to review the one-year follow-up to determine if the exposure to ketorolac versus placebo had any significant impact on long-term kidney function after LDKT.MethodsOne-year post hoc analysis of merged data from two ERAS LDKT, prospective, double-blind, randomized clinical trials were combined involving a total of 72 patients undergoing nephrectomy for LDKT. Kidney functions of both the ERAS groups' versus placebo were compared prospectively and blinded at one year using estimated glomerular filtration rate (eGFR) and total protein (TP) in the urine in compliance with United Network for Organ Sharing (UNOS) live donor requirements.ResultsThere was no significant difference in postoperative eGFR at one year between ERAS and placebo groups. TP urine at one-year post-operative was significantly lower in the ERAS cohort by 4.7 mg/dl (95% CI 0.48 ~ 8.82, p = 0.025).ConclusionsThe ERAS groups' exposure to ketorolac did not negatively affect kidney function at one year after LDKT.
Highlights
Live donors for kidney transplants risk opioid exposure following the surgery, which is a concern given the current opioid crisis
There was no significant difference in postoperative estimated glomerular filtration rate (eGFR) at one year between enhanced recovery after surgery (ERAS) and placebo groups
total protein (TP) urine at one-year post-operative was significantly lower in the ERAS cohort by 4.7 mg/dl
Summary
Live donors for kidney transplants risk opioid exposure following the surgery, which is a concern given the current opioid crisis. Few retrospective studies in transplant literature can be found that address narcotic alternatives [2,3], and even fewer long-term data exist This is a long-term post hoc analysis of merged data from two ERAS trials at a single center [4,5] seeking to understand how an enhanced recovery after surgery (ERAS) pathway using non-narcotic pain management including ketorolac versus standard of care (SOC) plus placebo in live donor nephrectomy transplant surgery affects kidney function. We previously theorized that an enhanced recovery after surgery (ERAS) pathway for LDKT will reduce perioperative narcotic use
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