1020 Robotic kidney transplantation with regional hypothermia: Results from a prospective two-arm non-randomized controlled trial (IDEAL Phase 2b)

Abstract

INTRODUCTION AND OBJECTIVES: Minimally invasive approaches to kidney transplantation (KT) have recently been described. We recently developed and described a novel technique of robotic KT (RKT) which allows intra corporeal graft cooling. Here, we sought to assess the comparative effectiveness of robotic and open KT (OKT) by evaluating peri and post-operative outcomes. METHODS: During Jan-May 2013, a total of 83 patients with end stage renal disease underwent KT at a tertiary referral center. Sixty six patients met the selection criteria and were enrolled into this prospective two-arm non-randomized controlled trial (IDEAL Phase-2b). Primary outcome was post transplant graft function. Secondary outcomes measured included surgical and immunologic complications, and peri-operative parameters. All patients had a minimum follow up of 6 months. RESULTS: Twenty five and 41 patients underwent RKT and OKT, respectively. There were no significant baseline differences between the two groups. Mean serum creatinine at discharge was 1.3 and 1.4 mg/dl in RKT and OKT patients, respectively (p1⁄40.71). Post-operative pain and analgesic requirements were significantly less in patients undergoing RKT (p1⁄40.01) (Fig 1). No patient undergoing RKT required post transplant dialysis whereas 2 (4.8%) patients undergoing OKT did. The incidence of lymphocele was markedly reduced in patients undergoing RKT detected by per protocol non contrast CT done at 3months (0% vs. 23.8%; p1⁄40.05; Fig 1). There was 1 graft loss in the OKT group; and 1 patient death (1.5 months post transplant secondary to congestive heart failure) in the RKT group (Table 1). CONCLUSIONS: RKT with regional hypothermia is safe and easily reproducible. Early outcomes are equivalent to OKT; with a propensity towards lower complications, quicker graft function recovery and shorter patient convalescence.