Pediatric Challenges in Robot-Assisted Kidney Transplantation.

Julien Grammens,Anne-Françoise Spinoit,Caroline Vanpeteghem,Liesbeth Desender,Tom Claeys,Ann Raes,Frank Vermassen,Céline Sinatti,Michal Yaela Schechter,Johan Vandewalle,Mesrur Selçuk Silay,Karel Decaestecker,Alberto Breda,Agnieszka Prytula

doi:10.3389/fsurg.2021.649418

Abstract

Kidney transplantation is universally recognized as the gold standard treatment in patients with End-stage Kidney Disease (ESKD, or according to the latest nomenclature, CKD stage 5). Robot-assisted kidney transplantation (RAKT) is gradually becoming preferred technique in adults, even if applied in very few centra, with potentially improved clinical outcomes compared with open kidney transplantation. To date, only very few RAKT procedures in children have been described. Kidney transplant recipient patients, being immunocompromised, might be at increased risk for perioperative surgical complications, which creates additional challenges in management. Applying techniques of minimally invasive surgery may contribute to the improvement of clinical outcomes for the pediatric transplant patients population and help mitigate the morbidity of KT. However, many challenges remain ahead. Minimally invasive surgery has been consistently shown to produce improved clinical outcomes as compared to open surgery equivalents. Robot-assisted laparoscopic surgery (RALS) has been able to overcome many restrictions of classical laparoscopy, particularly in complex and demanding surgical procedures. Despite the presence of these improvements, many challenges lie ahead in the surgical and technical–material realms, in addition to anesthetic and economic considerations. RALS in children poses additional challenges to both the surgical and anesthesiology team, due to specific characteristics such as a small abdominal cavity and a reduced circulating blood volume. Cost-effectiveness, esthetic and functional wound outcomes, minimal age and weight to undergo RALS and effect of RAKT on graft function are discussed. Although data on RAKT in children is scarce, it is a safe and feasible procedure and results in excellent graft function. It should only be performed by a RAKT team experienced in both RALS and transplantation surgery, fully supported by a pediatric nephrology and anesthesiology team. Further research is necessary to better determine the value of the robotic approach as compared to the laparoscopic and open approach. Cost-effectiveness will remain an important subject of debate and is in need of further evaluation as well.

Highlights

Kidney transplantation (KT) is universally recognized as the gold standard treatment in the adult and pediatric populations with patients with End-Stage Kidney Disease (ESKD).In contrast to the adult population, KT has taken longer to become an established and preferred treatment for pediatric patients with ESKD [1]
KT offers major advantages to the pediatric population such as catch-up growth [2] and longer survival [3].Immunosuppresive treatment increases the risk for perioperative surgical complications which creates additional challenges in management of kidney transplant recipients
robot-assisted kidney transplantation (RAKT) has become an increasingly common procedure in selected high-volume centers. This can be attributed to promising results which have indicated RAKT to be a safe, feasible and reproducible procedure with a potentially improved morbidity as compared to open kidney transplantation (OKT) [16, 17]

Summary

BACKGROUND

Kidney transplantation (KT) is universally recognized as the gold standard treatment in the adult and pediatric populations with patients with End-Stage Kidney Disease (ESKD). This can be attributed to promising results which have indicated RAKT to be a safe, feasible and reproducible procedure with a potentially improved morbidity as compared to open kidney transplantation (OKT) [16, 17] This evidence is largely limited to adults [16, 18, 19]. A prospective non-randomized open label trial by Patel et al [23] compared outcomes of open vs robot-assisted pediatric KT at a single center, involving 60 and 22 patients undergoing RAKT and OKT, respectively Endpoints of their trial were feasibility of RAKT and creatinine value at 30 days post-transplantation. We continue to monitor our data and hope to further develop our experience in this unique field and improve patient outcomes

DISCUSSION

CONCLUSION

DATA AVAILABILITY STATEMENT