Robotic-Assisted Kidney Transplantation from Living Donors: Single Center Experience

Abstract

Introduction: Robotic-assisted kidney transplantation (RAKT) is being adopted for renal transplantation in obese patients with ESRD. Methods: Consecutive RAKT procured via robotic live donor nephrectomy at our center between June 2018 and August 2021 were retrospectively analyzed. Our first 20 cases (Group I) were compared (student’s t-test and Fisher’s exact test, p < 0.05 significant) to the later 20 cases (Group II). Results: There was no difference in donor age (39.6±10.51 vs 38.4±12.14 years) or BMI (27.46±4.64 vs 29.48±4.06) between the two groups. 75% of recipients in both groups received a left kidney. A majority (>60%) of recipients in both groups were African Americans. Recipients in Group II were significantly older than in Group I. There was no significant difference in patient or graft survival or serum creatinine (1.67±0.99 mg/dL vs 1.93±0.55 mg/dL) at 1-year post-RAKT. One patient in group I died from respiratory failure due to COVID-19. The anastomosis times (35.16±7.75 vs 32.00±7.32 mins) were not significantly different, though the re-warming time was a significantly longer in our early experience (47.75±9.59 vs 42.00±6.55 mins, p = 0.016). The incidence of post-op washout (10%), ileus (10%), incisional hernia (5%) and delayed graft function (20%) were similar in both groups. Conclusion: Our early and more recent experience demonstrates that RAKT from living donors can be safely performed with excellent outcomes in obese, predominantly African American patients with ESRD. Practice paradigms are evolving to offer RAKT to patients with BMI >40 who may otherwise be considered ineligible for kidney transplantation.