121 The CRAFT Study - peri-operative Care and Recovery AFter Transplantation. A Trainee-Led Multicentre Prospective Cohort Study Investigating the Impact of Enhanced Recovery After Surgery (ERAS) in Kidney Transplantation

Abstract Background Perioperative complications are common in kidney transplantation, leading to increased length of stay (LOS) and costs. Enhanced recovery after surgery (ERAS) is well-established as a multimodal perioperative care pathway designed to reduce surgical stress and improve patient experience, however, its effectiveness in kidney transplantation remains largely unknown. Methods Participating centres included consecutive adult renal transplant recipients (live or deceased donors). 30-day follow-up data was prospectively collected. The primary outcome was LOS. Multivariable hierarchical models compared cohorts. Results 213 patients were included in the study period, 15th January - 15th February 2024. 8 centres reported no ERAS protocol, 5 a formal ERAS protocol and 7 delivered informal ERAS care. However, 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 (Clavien-Dindo ≥3) was 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; formal ERAS 14.3%, informal ERAS 17.0%, no ERAS 19.4%; p=0.721. Multivariable models confirmed these findings and demonstrated patients with WHO performance status ≥1 had longer LOS & more readmissions. Discussion Most UK renal transplant centres are delivering ERAS care. However, a formal ERAS protocol is not associated with decreased complications, LOS or readmissions. Therefore, efforts to improve perioperative outcomes for recipients should focus on treating frailty and prehabilitation of at-risk groups on the waiting list.