Introduction of an enhanced recovery protocol into a laparoscopic living donor nephrectomy programme

Area of Science:

• Nephrology
• Surgical Innovation
• Transplantation Medicine

Background:

• Living-donor renal transplantation is the preferred treatment for end-stage renal disease.
• Sub-optimal living donation rates in the UK may stem from donor concerns about postoperative recovery.
• Enhanced recovery programs (ERPs) are established for many surgeries but underutilized in living-donor procedures.

Purpose of the Study:

• To evaluate the impact of implementing an enhanced recovery protocol in a living-donor renal transplant program.
• To assess the safety and efficacy of ERPs for laparoscopic living-donor nephrectomy.

Main Methods:

• A 25-month study included consecutive patients undergoing laparoscopic living-donor nephrectomy.
• Key ERP principles: fluid restriction, morphine sparing, and expectation management.
• Outcomes measured: postoperative pain scores and complications for both donors and recipients.

Main Results:

• 70% of patients (57) followed the ERP, while 30% (24) received standard care.
• ERP patients had significantly less preoperative intravenous fluid (0ml vs. 841ml) and opiate medication (14.83mg vs. 23.85mg).
• Pain scores, postoperative complications, and recipient transplant outcomes were similar between groups.

Conclusions:

• Enhanced recovery protocols are safe and effective for living-donor nephrectomy.
• ERPs can improve the donor experience and potentially increase living donation rates.
• Further application and refinement of ERPs in living-donor surgery are recommended.