A comparative analysis of AWAKE vs standard kidney transplantation

Results from a single-center analysis comparing outcomes with Accelerated Surgery Without General Anesthesia in KidnEy Transplantation (AWAKE) kidney transplantation (AKT; n = 20) vs standard-of-care living donor kidney transplantation (SKT; n = 34), were presented by Vinayak Rohan at the 31st International Congress of The Transplantation Society (TTS), September 20–23, 2026, Sydney, AU. The study retrospectively analyzed prospectively collected data from kidney transplant procedures performed by the same two surgeons between May 2024 and October 2025. 

Key data: Compared with SKT, AKT was associated with shorter mean duration of kidney transplant surgery (80.9 minutes vs 124.0 minutes; p < 0.0001) and reduced anastomosis time (23.6 minutes vs 29.7 minutes; p < 0.001). Of the 20 patients who underwent AKT, 8 required no opioid medication, 9 required inpatient opioids, and 3 required outpatient opioid prescriptions. Mean morphine milligram equivalent (MME) per day was lower with AKT vs SKT for both inpatient (5.65 vs 19.45; p < 0.001) and outpatient (35.63 vs 99.61; p < 0.025) opioid use. Mean postoperative hospital stay was 2.20 days with AKT vs 3.18 days with SKT (p = 0.068). Of the patients who underwent AKT, 18 were discharged within <48 hours, including 4 who were discharged within <23 hours.  

Key learning: In this analysis, the AWAKE protocol appears safe and feasible in kidney transplant recipients and is associated with significantly lower opioid requirements compared with SKT. These findings support AWAKE as an alternative approach to kidney transplantation, although larger prospective studies are needed to validate the results.