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Multicentre Collaborative Prospective Cohort Study Investigating the Impact of Enhanced Recovery After Surgery on Kidney Transplant Outcomes: The CRAFT Study

Abstract:
Perioperative complications are common in kidney transplantation. Enhanced recovery after surgery (ERAS) is a well-established multimodal perioperative care pathway designed to improve patient outcomes, however, its efficacy in renal transplant remains poorly described. Participating centres included adult renal transplant recipients and 30-day follow-up data. The primary outcome was LOS. Multivariable hierarchical models compared cohorts. 213 patients were included in the study period. 18/23 UK kidney transplant centres were represented. Analysis of the perioperative care delivery demonstrated similar patterns irrespective of reported protocols, with a tendency towards ERAS-type care. Between cohorts, the incidence of complications were similar; formal ERAS 14.3%, ERAS informal 17.0%, no ERAS 12.6%; p = 0.64. Median LOS was also similar; formal ERAS 6.0 days (5.0–11.5), informal ERAS 7.0 days (5.0–10.5) vs. no ERAS 6.0 days (5.0–10.5); p = 0.75. Readmissions were comparable; p = 0.721. Multivariable models confirmed these findings and demonstrated frailer patients had longer LOS and more readmissions. Currently, most UK renal transplant centres deliver a form of peri-operative ERAS care, indicating broad adoption of ERAS principles. Consequently, a formal ERAS protocol is not associated with decreased complications, LOS or readmissions. Efforts to improve outcomes should focus on prehabilitation of at-risk groups on the waiting list.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.3389/ti.2025.15541

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Publisher:
Frontiers Media
Journal:
Transplant International More from this journal
Volume:
38
Article number:
15541
Publication date:
2026-01-14
Acceptance date:
2025-12-12
DOI:
EISSN:
1432-2277
ISSN:
0934-0874


Language:
English
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Pubs id:
2361422
Local pid:
pubs:2361422
Source identifiers:
3661465
Deposit date:
2026-01-14
ARK identifier:
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