Enhanced Recovery After Surgery in Simultaneous Pancreas–Kidney Transplantation: A Retrospective Cohort Analysis of Perioperative Outcomes
Rongxin Chen, Luhao Liu, Jialin Wu, Zhuangqiang Fang, Guanghui Li, Zheng ChenABSTRACT
Background
While simultaneous pancreas–kidney transplantation (SPK) is an established therapeutic intervention for patients with end‐stage renal disease and diabetes, it has been associated with prolonged recovery periods and high complication rates. In this study, we aimed to investigate the impact of a perioperative enhanced recovery after surgery (ERAS) protocol on clinical outcomes in SPK recipients.
Methods
This single‐center retrospective cohort study enrolled 267 patients who underwent SPK transplantation between January 2016 and December 2025. Eligible ones were categorized into the ERAS and standard care (SC) groups. Primary outcomes included pneumonia and urinary tract infection (UTI), while secondary outcomes comprised length of stay (LOS), graft function, and inflammatory biomarkers.
Results
In total, 214 patients were included, with 109 receiving ERAS and 105 receiving SC. The ERAS group had significantly lower pneumonia incidence (15.6% vs. 27.6%, p = 0.032) and UTI incidence (11.9% vs. 22.9%, p = 0.035) than the SC group. Additionally, LOS was shorter in ERAS (33.80 ± 9.59 days vs. 37.10 ± 13.76 days, p = 0.045). In multivariable analysis adjusted for age, dialysis duration, and modality, ERAS was independently associated with reduced pneumonia (odds ratio [OR]: 0.474; 95% confidence interval [CI]: 0.238–0.944; p = 0.034), reduced UTI (OR: 0.409; 95% CI: 0.191–0.878; p = 0.022), and shorter LOS ( β = −3.45 days; 95% CI: −6.70– −0.20, p = 0.038). The ERAS group also showed lower interleukin‐6 levels at postoperative day (POD) 3 (12.13 ± 6.14 vs. 15.71 ± 12.56 pg/ml, p = 0.008) and POD 7 (10.88 ± 6.58 vs. 14.29 ± 10.73 pg/ml, p = 0.006).
Conclusions
Implementing a perioperative ERAS protocol for SPK recipients can potentially accelerate recovery and reduce infectious complications, with an acceptable safety profile. However, prospective validation is warranted.