Transplant Trial Watch

Prospective, double blind, randomized clinical trial comparing an ERAS pathway with ketorolac and pregabalin versus standard of care plus placebo during live donor nephrectomy for kidney transplant.

Campsen, J., Call, T. et al.

American Journal of Transplantation, 2018 [record in progress].

To determine whether, in donor nephrectomies, the use of a non-opioid analgesic for the Enhanced Recovery After Surgery (ERAS) protocol could decrease narcotics used, without increasing the complications of a patient.

Participants were randomized to either the ERAS group, receiving ketorolac and pregabalin (n=33) or the control group, receiving standard treatement and placebo (n=29).

62 patients, undergoing nephrectomy for live donor kidney transplantation (>18 years).

Primary outcomes were assessed as renal function alongisde secondary outcomes. Secondary endpoints included length of stay, operative time, hematocrit (Hct) levels and 30‐day postoperative mortality.

48 hours

CET Conclusions
This small single-centre study investigates the use of an enhanced recovery (ERAS) pathway following living kidney donation. Patients were randomized to receive either standard of care (mainly opiate-based analgesia), or standard of care plus pre-operative pregabalin and post-operative ketorolac. The authors demonstrate equivalent creatinine change, a reduction in opiate use in the ERAS group, with a reduction in length of hospital stay. The study is well designed, with use of placebo and double blinding. The clinical significance of the reduction in hospital stay (6 hours) is questionable, but the reduction in opiate use is likely to be clinically significant. The authors do not look at opioid-related side effects (e.g. constipation) or outcomes following hospital discharge. It would be interesting in future studies to look at longer-term outcomes such as opiate use following discharge, return to normal function and return to work.

Jadad score

Data analysis
Per protocol analysis

Allocation concealment

Trial registration - NCT0366908

Funding source
Not reported