SUN-125 ROBOT ASSISTED KIDNEY TRANSPLANTATION - NEPHROLOGIST'S PERSPECTIVE

Abstract

Robot assisted kidney transplantation , being a minimally invasive procedure, is said to offer certain advantages to the recipient : quicker recovery time, less blood loss, less wound infections, less post operative pain, and better cosmesis , when compared to open surgery. Aim of the study: To compare our experience of Robot assisted kidney transplantation (RAKT) with open kidney transplantation (OKT) surgery done by the same surgeon. Study of all robot assisted kidney transplantations (RAKT - group 1) done by a surgeon experienced in laparoscopic and robot assisted surgeries, from January 2015 to October 2018 in adult recipients (age above 18 years). Clinical data, outcomes and complications were analysed; this data was compared to recipients who underwent open kidney transplantation surgery (OKT -group 2) by the same surgeon during the same period. The donors were either first degree relatives (80%) or spouses (20%). The graft was positioned extraperitoneally. Both groups received identical immunosuppression according to our protocol - Tacrolimus ( initial dose of 0.1mg/kg/day) to maintain trough levels of 6 to 12 ng/ml in the first three months and subsequently 3 to 6ng/ml, Mycophenolate Mofetil ( 35mg/kg/day) and Prednisolone (0.5mg/kg/day initially , tapering to 0.125mg per day by 3 months). Total surgery time, cold ischemia time, blood loss, postoperative pain score by visual analogue scale, delayed graft function, reexploration rate, incidence of urinary tract & wound infections, length of hospital stay, length of surgical scar , and graft function in the two groups were studied. Statistical analysis was done using Students T test, Chi-Square test and Mann-whitney test. There were 54 recipients (38 males 16 females) in RAKT group and 104 (77 males 27 females ) in OKT group. The mean duration of follow up was 25 ± 10 months ( 1 month to 46 months). The two groups were comparable for recipient and donor age, gender, HLA match, diabetic status and number of graft arteries (Table I) . Body Mass Index was significantly higher in RAKT group (p < 0.001) . Table II shows the cold ischemia time, total surgery time, need for blood transfusions in the first 48 hours after surgery, pain score by Visual Analogue Scale for 48 hours, delayed graft function, reexploration rate, length of hospital stay, length of surgical scar . The need for blood transfusions , pain score, length of hospital stay and length of scar were less in RAKT group. Surgical site and urinary infectons and reexplorations were similar. There was no difference between the two groups in incidence of delayed graft function or graft function at 1, 6 and 12 months after surgery (Table III). The death censored graft survival was 99% in RAKT group and 98% in OKT group at the end of follow up for 3 years.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Robot Assisted Kidney transplantation is associated with less blood loss & postoperative pain, shorter hospital stay and better cosmesis , when compared to open surgery, especially in recipients with high BMI. Graft function is not affected by RAKT. As minimally invasive surgical procedures would be preferred in the days ahead, robot assisted kidney transplantation done by an experienced surgeon would offer certain distinct advantages to the recipeints.