Superior Two-Year Graft Survival After Robotic Kidney Transplantation in Obese Recipients: Does Wound Infection Really Matter?

Abstract

Introduction We hypothesize that robotic kidney transplant (R-KT) in obese individual could decrease the rate of surgical site infections (SSI) and improve outcomes Materials and Methods From June 2009 to October 2013, a prospective cohort of 90 morbidly obese patients underwent R-KT at our Institution. Twenty-eight of these patients in robotic group (RG), with a follow-up period of 24 months after transplant, were frequency matched with a control group (CG) of 28 morbidly obese patients who underwent standard open KT. Results The mean BMI was 42.6±7.8 kg/m2 in RG and 38.1±5.4 kg/m2 in CG (p=0.02). Two of 28 patients in each group underwent deceased donor KT, while the remaining patients had a living donor KT.Seven patients in the RG and five patients in the CG experienced biopsy proven acute rejection (p=NS). The mean follow-up was 28±8.8 months in RG and 54±24.6 months in CG. At 24 months after transplant, the GFR was 54.5±18.1 ml/min/1.73m2 in RG and 60.6±21.8 ml/min/1.73m2 in CG (p=NS). The rate of SSI was significantly higher in the CG in comparison with the RG (28.6% vs. 0%, p=0.004). At two year post transplant, 8 patients in the CG (28.5%) in comparison to only one in the RG (3.5%) experienced graft loss; the difference was statistically significant (p=0.02). Only two patients out of the eight who lost the graft in the CG had concomitant SSI. The patients survival at 24 months was 96.5% in robotic group and 92.8% in control group (p=NS). Conclusions At two year follow-up, we have documented a statistically significant improvement in graft survival in the robotic group. The decreases rate of SSI can explain only partially the improved graft survival. Further study is currently on going to identify other pertinent factors.