Robotic Kidney Transplant in Morbid Obesity.

Abstract

Introduction Morbidly obese patients are often denied access to kidney transplantation (KT) due to increased risk of post-surgical complications. Surgical site infection risk in morbid obese patients increases to 40% from 5% in normal weight recipients, which is directly correlated with poor graft function and survival. However, the robot-assisted approach to kidney transplantation in patients with class III obesity (BMI ≥ 40 kg/m2) was designed to reduce wound complications by modifying the location of incisions Methods Between June 2009 and December 2013, 60 class III obese patients (BMI ≥ 40 kg/m2) underwent robotic assisted KT at our institution. This is a retrospective chart review, analyzing intra-operative and post-operative data as well as the short-term outcomes Results Most transplants were from a living donor (88.3%). The intra-operative data is shown in Table 1. The mean follow-up period was 16.5±13.3 months. The mean age was 47.3±9.4 yrs with a mean BMI of 46.7±5.2kg/m2. The SSI rate was 1.6% and four patients developed a non-infected seroma. There was 1 evisceration through the epigastric incision and 1 urinary leak that was managed surgically with full robotic approach and one conversion to open surgery due to inadequate exposure. The mean calculated GFR at 1 month was 43.5±16.2 ml/min/1.73m2 with a 6.6% delayed graft function rate (n=4). The 1-yr patient and graft survival rates were 98% and 95% respectively, where one patient expired with graft function, one graft failed due to antibody mediated rejection and one graft failed at 7 months due to torsion.Table: No Caption available.Discussion The robotic approach to kidney transplantation in patients withBMI ≥ 40 kg/m2 yields excellent patient and graft survival, with dramatic reduction in the surgical infection rates. Robotic kidney transplantation in class III obese offers equivalent outcomes to those in normal weight candidates. In our opinion, this procedure should be encouraged