Abstract
Objective: The objective of this preliminary study was to report and compare the peri-operative and functional results of ABO-incompatible (ABOi) living-donor robotic-assisted kidney transplantation (RAKT), ABO-compatible (ABOc) living-donor RAKT, and ABOi living-donor open kidney transplantation (OKT).Materials and Methods: For the present retrospective study, we analyzed data of consecutive patients who underwent ABOi or ABOc-RAKT and ABOi-OKT, from January 2015 to December 2019, in one French academic center. Patients' baseline characteristics, operative, and functional outcomes were compared between ABOi-RAKT, ABOc-RAKT, and ABOi-OKT.Results: 29 RAKT, including 7 ABOi-RAKT, and 56 ABOi-OKT were performed in our center. Median follow-up was 2.0 years. Median recipient age, pre-emptive kidney transplantation rate, sex ratio and desensitization procedures were similar in ABOi-RAKT, ABOc-RAKT, and ABOi-OKT groups. Recipient BMI at transplantation was statistically higher in ABOi and ABOc-RAKT groups compared to ABOi-OKT. The surgical site complication (principally infection-related) rate was lower in ABOi-RAKT, without statistical differences (0 vs. 8.9%, respectively, in ABOi-RAKT and ABOi-OKT, p = 0.7). The delayed graft function rate was 0% in ABOi-RAKT, 13.6% in ABOc-RAKT, and 10.7% in ABOi-OKT (p = 0.6). The post-transplantation blood transfusion rate was statistically higher in the ABOi-OKT group (14.3 vs. 13.6 vs. 57.1% in ABOi-RAKT, ABOc-RAKT, and ABOi-OKT, respectively, p = 0.001). The kidney graft survival at 1 month and at last follow-up was not different between ABOi-RAKT and ABOi-OKT.Conclusion: Our data support the use of ABOi-RAKT to restore accessibility to kidney transplantation for obese patients to the greatest extent possible. Large series are required to confirm these encouraging data from a single center.
Highlights
Kidney transplantation (KT) is the best treatment for obese patients suffering from end-stage renal disease, but remains a daily surgical challenge [1]
Pre-emptive KT rate and sex ratio were similar in ABOiRAKT, ABOc-robotic-assisted kidney transplantation (RAKT), and ABOi-open KT (OKT) groups
Recipient body mass index (BMI) at transplantation was statistically higher in ABOi and ABOc-RAKT groups, compared to ABOi-OKT [33.1 (29.4–35.6) vs. 32.2 (30.1–35.0) vs. 23.0 (20.6–25.3) kg/m2 in ABOi-RAKT, ABOc-RAKT, and ABOi-OKT, respectively, p < 0.0001]
Summary
Kidney transplantation (KT) is the best treatment for obese patients suffering from end-stage renal disease, but remains a daily surgical challenge [1]. Several studies reported technical difficulties with traditional open approaches and a higher surgical post-operative complication rate, including wound dehiscence, surgical site infection, and lymphocele formation, in obese recipients [1, 2]. Compared to remaining on a waiting list, KT in obese recipients improves long-term survival [3] and enhances quality of life [4]. Despite excellent long-term reported outcomes [6], post-operative surgical complications, especially bleeding complications, were more frequent after ABOi living-donor kidney transplantation compared to ABO-compatible (ABOc) living-donor kidney transplantation [7]
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