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

## TL;DR

This study found that formal ERAS protocols in kidney transplants do not reduce complications or hospital stays, suggesting a focus on pre-transplant care for better outcomes.

## Contribution

The study is the first multicenter investigation of ERAS in kidney transplantation, revealing no benefit from formal ERAS protocols and highlighting the need for prehabilitation.

## Key findings

- Formal ERAS protocols were not associated with reduced complications, length of stay, or readmissions.
- Most UK transplant centers already use ERAS-like care, indicating widespread adoption of its principles.
- Frailer patients had longer hospital stays and more readmissions, suggesting pre-transplant interventions are needed.

## 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.

Multicenter collaborative study on enhanced recovery after kidney transplant, involving 18 UK transplant units. Graphs show length of stay, post-op complications, readmissions, and 30-day GFR across ERAS groups. Key points include comparable outcomes and widespread ERAS adoption. Lack of prehabilitation interventions noted. Study by Ruth Owen et al., published in Transpl. Int. 2025.