Robot-assisted kidney transplantation: a propensity score-matched cohort analysis of early experience

Abstract

Background: Kidney transplantation is the preferred treatment for patients with end-stage kidney disease. Since the introduction of robot-assisted kidney transplantation (RAKT), several centers have applied this technique as an alternative to open kidney transplantation (OKT). The objective of this study is to analyze our early experience, focusing on surgical technique and learning curve, and postoperative outcomes of RAKT. Methods: We retrospectively reviewed 782 living donor kidney transplantation recipients between January 2018 and January 2024. A propensity score-matched cohort of 50 RAKT and 150 OKT patients was evaluated for intraoperative and postoperative variables. Shewhart control charts and CUSUM analysis were used to evaluate technical outcomes and learning curves of RAKT. Postoperative eGFR values, complications, and biopsy results were compared for overall graft function and safety. Results: RAKT patients were associated with significantly longer overall operative, rewarming, and anastomosis times. Although overall postoperative eGFR trends showed comparable graft function between RAKT and OKT recipients (51.35±2.64 vs. 54.01±1.45; P=0.315), RAKT patients with extremely long rewarming times exhibited aggravated chronic scores at 1 year protocol biopsies (Δ Chronicity Index = 4.45±1.92, P<0.001). CUSUM analysis of rewarming time revealed that proficiency in RAKT is achieved after approximately 15 cases. Conclusions: Despite longer anastomosis and ischemic times, even during the early stages of RAKT adoption, the RAKT group did not differ significantly in graft function or postoperative complications from the OKT group.