Cases Of Kidney Transplantation Research Articles

The impact of donor hepatitis B virus infection on transplant outcomes in deceased donor kidney transplantation recipients.

The use of hepatitis B virus (HBV)-positive donor kidneys to expand the donor pool has been implemented, but limited evidence exists regarding their impact on transplant outcomes. This study aimed to investigate the effects of donor HBV infection on transplant outcomes. Donor and recipient data between 2015 and 2021 were collected. A total of 743 kidney transplant cases were screened, including 94 donor hepatitis B surface antigen (HBsAg)+/recipient HBsAg- (D+R-) and 649 donor HBsAg-/recipient HBsAg- (D-R-) cases. The analysis endpoints included recipient HBV infection, delayed graft function (DGF), peak estimated glomerular filtration rate (eGFR) within 12 months, recipient survival, and death-censored graft survival (DCGS). The D+R- group had a significantly higher risk of HBV infection compared to the D-R- group (6/72 vs. 3/231; relative risk, 6.4; p = 0.007). The risk of HBV transmission decreased significantly with increasing hepatitis B surface antibody (HBsAb) titer (p for trend = 0.003). Furthermore, the D+R- group did not exhibit an increased risk of DGF compared to the D-R- group (odds ratio, 0.70; p = 0.51) in the multivariable mixed model. Both groups had similar peak eGFR within 12 months (β = 1.01, p = 0.71), and this had no impact on patient survival (hazard ratio [HR], 0.36; p = 0.10) and DCGS (HR, 0.79, p = 0.59) in the shared-frailty Cox model. The use of HBsAg-positive donor kidneys appears relatively safe for HBV-immunized recipients in the short term. D+R- does not negatively affect graft function recovery and provides comparable posttransplant outcomes. Maintaining an HBsAb titer over 100 IU/L before transplantation is critical to reduce the risk of HBV transmission.

Takotsubo cardiomyopathy after solid organ transplantation: a scoping review.

Takotsubo syndrome (TTS) is a stress-induced cardiomyopathy that causes temporary left ventricular wall motion abnormalities and abrupt reversible heart failure. The incidence of perioperative TTS is proportional to the severity of surgical trauma, the duration of the procedure, and the degree of apparent sympathetic activity. A growing number of articles have discussed TTS after a solid organ transplant (SOT), which is one of the circumstances in which physical and emotional stress are at their highest levels. The majority of published cases involved patients who had received an orthotopic liver transplant (OLT). TTS occurred in 0.3-1.7% of liver transplant recipients, but a limited number of cases of TTS in patients who had received kidney, heart, or lung transplants have also been documented. In this study, we analyzed the TTS instances that developed after SOT, highlighting the symptoms and causes as well as the various treatment approaches that were applied. Most TTS cases following OLT and kidney transplant cases occurred in the first week of the surgery. However, the majority of cases occurred years after heart transplantation. Dizziness, dyspnoea, and chest discomfort are the most typical symptoms. Patients may also experience syncope and generalized weakness. In spite of this, the symptoms differ depending on the transplanted organ. Dyspnoea is a common symptom after lung transplants, whereas chest discomfort and dizziness are a common symptom after liver and kidney transplants. Yet, chest pain is not a typical symptom after a heart transplant.

COVID-19 in Dialysis and Kidney Transplant Patients

COVID-19 problems are more common in recipients of kidney transplants. There is, however, a dearth of information on the likelihood of allograft damage or death in kidney transplant recipients recuperating with COVID-19. Objective: To investigate the effect of Covid-19 on kidney transplant and dialysis patients. Methods: This Retrospective study was conducted at Department of Medicine, Avicena Medical College, Lahore from 1st October 2022 to 31st March 2023. One hundred patients with age >18 years being kidney patients diagnosed with kidney failure or had a kidney allograft were included. Patients were grouped as either kidney transplant (Group A) or hemodialysis (Group B) where both groups were Covid-19 positive on diagnosis. The score represented 1 as fit and 9 as terminally ill. Any comorbidity related with these patients apart from the kidney failure was recorded including their obesity level. The eGFR (estimated glomerular filtration rate) was considered as zero in dialysis cases with residual diuresis ≤ 200 mL/day and 5 mL/min/1.73 m2. Results: There were 40% kidney transplant patients positive with Covid-19 infection and 60% with hemodialysis having positive Covid-19 infection. Majority of the patients in both groups A and B were males with a percentage of 57.5% and 59.4% respectively. The clinical frailty score was higher in group B than A. Odds ratio results showed that 28 days probability risk ratio of death was higher in the kidney transplant group A patients suffering from Covid-19 virus than hemodialysis. Conclusions: Kidney transplant cases have higher severity of complication and death in cases where patients become corona virus positive.

Four Cases of Kidney Transplants With Donor HCV-Derived Immune Complex Glomerulonephritis

Four Cases of Kidney Transplants With Donor HCV-Derived Immune Complex Glomerulonephritis

Abstract P415: Validation of an Algorithm to Identify End-Stage Kidney Disease Cases in Electronic Health Record Data

Introduction: End-stage kidney disease (ESKD) is an important clinical outcome. However, there is limited work on validating algorithms to detect ESKD cases within electronic health record (EHR) data. Hypothesis: Algorithms using diagnostic and procedure codes in EHR data can accurately identify ESKD cases. Methods: Using data from Geisinger linked to the United States Renal Data System (USRDS), we developed algorithms to identify individuals with ESKD (either dialysis or kidney transplant, whichever occurred first) and validated them against ESKD cases ascertained from the USRDS data from January 1, 1996, through June 28, 2018 (gold standard). We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: To identify dialysis cases, we required 1) diagnosis codes of stage 5 chronic kidney disease or ESKD with dialysis codes within seven days or 2) three dialysis codes lasted longer than a month with any two consecutive codes occurring within 3 months. To identify kidney transplant cases, we required 1) one procedure code of kidney transplant or 2) one diagnosis code of kidney transplant in inpatients or problem list. Among 572,574 individuals (mean age, 41.6 years; female, 55.4%; White, 92.9%), the algorithms identified 4,187 ESKD cases (3,875 dialysis and 792 kidney transplant cases), while there were 4,529 ESKD cases (4,368 dialysis and 772 kidney transplant cases) by USRDS data. Our ESKD identifying algorithms’ sensitivity, specificity, PPV, and NPV were 71.1%, 99.8%, 76.9%, and 99.8%, respectively. Median (interquartile range) duration between incident dates by the algorithm and by the USRDS was -2 (-21, 86) days ( Table ). Conclusions: The algorithms developed by diagnostic and procedure codes accurately identified ESKD cases with high specificity in EHR data. Further validation is required in different health systems. Table The validity of the algorithms to identify ESKD cases IQR: interquartile range

Patient Factors and Their Effect on Operating Room Time for Urologic Procedures

Patient Factors and Their Effect on Operating Room Time for Urologic Procedures

Novel factors potentially initiating acute antibody-mediated rejection in pig kidney xenografts despite an efficient immunosuppressive regimen.

Antibody-mediated rejection (AMR) is a common cause of graft failure after pig-to-nonhuman primate organ transplantation, even when the graft is from a pig with multiple genetic modifications. The specific factors that initiate AMR are often uncertain. We report two cases of pig kidney transplantation into immunosuppressed baboons in which we identify novel factors associated with the initiation of AMR. In the first, membranous nephropathy was the initiating factor that was then associated with the apparent loss of the therapeutic anti-CD154 monoclonal antibody in the urine when severe proteinuria was present. This observation suggests that proteinuria may be associated with the loss of any therapeutic monoclonal antibody, for example, anti-CD154 or eculizumab, in the urine, resulting in xenograft rejection. In the second case, the sequence of events and histopathology tentatively suggested that pyelonephritis may have initiated acute-onset AMR. The association of a urinary infection with graft rejection has been well-documented in ABO-incompatible kidney allotransplantation based on the expression of an antigen on the invading microorganism shared with the kidney graft, generating an immune response to the graft. To our knowledge, these potential initiating factors of AMR in pig xenografts have not been highlighted previously.

Clean Intermittent Catheterization in Children under 12 Years Does Not Have a Negative Impact on Long-Term Graft Survival following Pediatric Kidney Transplantation.

Congenital anomalies of the kidneys and urinary tract (CAKUTs) are one of the most prevalent primary causes of end-stage renal disease (ESRD) in young children, and approximately one-third of these children present with lower urinary tract dysfunction (LUTD). Many children with LUTD require therapy with clean intermittent catheterization (CIC). CIC commonly leads to bacteriuria, and considerations have arisen regarding whether CIC in immunosuppressed children is safe or whether repeated febrile urinary tract infections (UTIs) may lead to the deterioration of kidney graft function. We retrospectively reviewed all cases of primary kidney transplantation performed in our center between 2001 and 2020 in recipients aged less than twelve years. The number of episodes of febrile UTIs as well as the long-term kidney graft survival of children undergoing CIC were compared to those of children with urological causes of ESRD not undergoing CIC, as well as to those of children with nonurological causes of ESRD. Following successful kidney transplantation in 41 children, CIC was needed in 8 of these patients. These 8 children undergoing CIC had significantly more episodes of febrile UTIs than did the 18 children with a nonurological cause of ESRD (p = 0.04) but not the 15 children with a urological cause of ESRD who did not need to undergo CIC (p = 0.19). Despite being associated with a higher rate of febrile UTIs, CIC was not identified as a risk factor for long-term kidney graft survival, and long-term graft survival did not significantly differ between the three groups at a median follow-up of 124 months. Our study demonstrates that, under regular medical care, CIC following pediatric transplantation is safe and is not associated with a higher rate of long-term graft loss.

Predictors of graft function and survival in second kidney transplantation: A single center experience.

The increasing kidney retransplantation rate has created a parallel field of research, including the risk factors and outcomes of this advanced form of renal replacement therapy. The presentation of experiences from different kidney transplantation centers may help enrich the literature on kidney retransplantation, as a specific topic in the field of kidney transplantation. To identify the risk factors affecting primary graft function and graft survival rates after second kidney transplantation (SKT). The records of SKT cases performed between January 1977 and December 2014 at a European tertiary-level kidney transplantation center were retrospectively reviewed and analyzed. Beside the descriptive characteristics, the survivals of patients and both the first and second grafts were described using Kaplan-Meier curves. In addition, Kaplan-Meier analyses were also used to estimate the survival probabilities at 1, 3, 5, and 10 post-operative years, as well as at the longest follow-up duration available. Moreover, bivariate associations between various predictors and the categorical outcomes were assessed, using the suitable biostatistical tests, according to the predictor type. Out of 1861 cases of kidney transplantation, only 48 cases with SKT were eligible for studying, including 33 men and 15 women with a mean age of 42.1 ± 13 years. The primary non-function (PNF) graft occurred in five patients (10.4%). In bivariate analyses, a high body mass index (P = 0.009) and first graft loss due to acute rejection (P = 0.025) were the only significant predictors of PNF graft. The second graft survival was reduced by delayed graft function in the first (P = 0.008) and second (P < 0.001) grafts. However, the effect of acute rejection within the first year after the first transplant did not reach the threshold of significance (P = 0.053). The mean follow-up period was 59.8 ± 48.6 mo. Censored graft/patient survival rates at 1, 3, 5 and 10 years were 90.5%/97.9%, 79.9%/95.6%, 73.7%/91.9%, and 51.6%/83.0%, respectively. Non-immediate recovery modes of the first and second graft functions were significantly associated with unfavorable second graft survival rates. Patient and graft survival rates of SKT were similar to those of the first kidney transplantation.

Retrospective review of seven thousand kidney transplant cases at Asan Medical Center: patient demographics and graft survival analysis

Retrospective review of seven thousand kidney transplant cases at Asan Medical Center: patient demographics and graft survival analysis

Risk Factor Analysis for Long-Term Graft Survival Following Pediatric Kidney Transplantation: The Importance of Pretransplantation Time on Dialysis and Donor/Recipient Age Difference.

Recognizing risk factors that may negatively affect long-term graft survival following pediatric kidney transplantation is a key element in the decision-making process during organ allocation. We retrospectively reassessed all cases of pediatric kidney transplantation performed in our center in the last 20 years with the aim of determining baseline characteristics that could be identified as prognostic risk factors for long-term graft survival. Between 2001 and 2020, a total of 91 kidney transplantations in children under the age of 18 years were undertaken in our center. Early graft failure was observed in six of the 91 patients (7%). The median follow-up of the remaining 85 children was 100 months, and the overall kidney graft survival rates at 5, 10, 15 and 20 years were 85.2%, 71.4%, 46.0% and 30.6%, respectively. Small children with a body surface area of <1 m2 were significantly associated with better long-term graft survival outcomes, while adolescents aged more than twelve years showed poorer graft survival rates than younger children. Body surface area of the recipient of ≥1 m2, pretransplantation duration of the recipient on dialysis ≥18 months, hemodialysis prior to transplantation and donor/recipient age difference of ≥25 years were significantly associated with poorer long-term graft survival.

Uncovering gender bias in health services: the case of kidney transplantation

Abstract Gender-based inequalities of access to health care are major public health issues. Studies performed in several countries and in some French regions showed that women had less access to kidney transplantation waiting list (KTWL) than men. Through a quantitative study based on REIN registry data, we analysed gender-based disparities in the access to KTWL in France. All incident patients who initiated dialysis from 2017 to 2019 and aged between 18 and 85 years old were included. Cox proportional hazard models, adjusted on age, comorbidities and neighbourhood deprivation level using European Deprivation Index (EDI), at national level and in all French regions, were performed. Among 29 395 patients who started dialysis in 2017-2019, 35% were women. 40% of women and 34% of men lived in most deprived areas. Men were more comorbid than women at dialysis start. At the national level, women had less access to the KTWL compared to men one and three years after dialysis start. Analyses were stratified by age (&amp;lt;60 and ≥ 60 years old). Only women aged more than 60 had less access to the KTWL one year (adjHR: 0.76 [0.71 - 0.82]) and three years (adjHR: 0.75 [0.71 - 0.81]) after dialysis start. At regional level, the same trends were found in Nouvelle Aquitaine and Pays de Loire one year after dialysis start and two more regions (Bourgogne-Franche-Comté and Île-de-France) 3 years after dialysis start. Gender-based disparities in KTWL persist even after controlling for EDI and comorbidities, especially among women over 60. These results are issued from a health service research project on gender-based disparities of access to KTWL in France. A qualitative study is ongoing to better understand the reasons of these disparities. Patients’ perspectives on Kidney transplantation and nephrologists’ practices are studied using Semi-structured interviews in three French regions.

Efficacy and prognosis of infant kidney transplantation

Objective: To analyze the effect and prognosis of infant kidney transplantation. Methods: Clinical data of 37 cases of infant kidney transplantation under 3 years old in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 1, 2017 to July 31, 2022 were retrospectively collected. These 37 cases included 31 primary kidney transplantation and 6 secondary kidney transplantation. Kaplan-Meier method was used to draw the survival curve of the transplanted kidney and the recipient, and the prognosis and complications were analyzed. Median follow-up was 18 months (range: 6-66 months). Results: The recipients were 20 males and 17 females, with a median age of 16 months (range: 2 months, 26 days to 36 months) and a median weight of 8 kg (range: 3.2 to 14.0 kg). The youngest child was only 2 months, 26 days old, and weighed only 3.2 kg. The most common primary disease of recipients was congenital nephrotic syndrome (13 cases, 41.9%). Intra-abdominal transplantation occurred in 19 cases (51.3%) and intra-iliac fossa transplantation occurred in the remaining 18 cases (48.6%). Postoperative renal function recovery was delayed in 7 cases (18.9%), and thrombosis caused renal function loss in 5 cases (13.5%), of which 4 cases received second renal transplantation and were successful. During the follow-up period, there were 11 cases of acute rejection (29.7%) and 6 cases of CMV pneumonia (16.2%). The estimated glomerular filtration rate 1 year after transplantation was higher than that 1 month after surgery [(101.9±22.1) vs (71.1±25.6) ml/(min·1.73m2), P<0.001], and remained constant 2 years after transplantation. Both the 1-year and 2-year survival rates of the transplanted kidney were 85.3%, and both the 1-year and 2-year survival rates of the recipients were 96.8%. Conclusion: Although the implementation of infant kidney transplantation is difficult, it can still achieve relatively satisfactory efficacy and prognosis.

Recent trends in perioperative blood transfusion during elective kidney transplantation.

Accurately predicting the demand for blood transfusions is crucial for blood banks. Given the potential for emergency situations, it is imperative that blood banks maintain a sufficient inventory of blood products. In this study, we examined the use of perioperative transfusions in patients undergoing elective kidney transplants. Data on all complement-dependent cytotoxicity-crossmatched assays between 2013 and 2022 were collected. We excluded repeated assays and patients who did not undergo kidney transplantation. Transfusion records and transfusion adverse reactions were reviewed retrospectively. In total, 30 patients underwent elective kidney transplantation from 2013 to 2022. The mean age of the patients was 48.1±9.7 years. The male-to-female ratio was 1.5:1. Four patients received transfusions intraoperatively, whereas eight patients were transfused postoperatively. The postoperative hemoglobin level of the transfusion group (n=9, 8.9±1.3) was significantly lower than that of the nontransfusion group (n=21, 10.4±1.2). The most commonly transfused blood product intraoperatively was leuko-reduced filtered red blood cells, followed by fresh frozen plasma. When the study period was divided into two halves based on the time of operation, the first half showed a higher number of significant transfusions. In most elective kidney transplant cases, surgery was conducted without the need for blood transfusion. The timing of transfusion, when necessary, shifted from during the operation to after the operation. The implementation of patient blood management, coupled with advancements in surgical techniques, appears to have impacted the pattern of perioperative transfusion.

Successful Kidney Transplantation of Two Patients with Donors Positive for Severe Acute Respiratory Syndrome Coronavirus Infection

Despite preventative measures, including vaccination, severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection may result in severe illness, particularly in immunosuppressed transplant recipients. This has had a negative impact on organ donation and transplantation rates. However, the risk of transmission from SARS-CoV-2 positive donors to kidney transplant recipients is unknown. We describe 2 cases of successful kidney transplantation from SARS-CoV-2 positive donors. Case 1: 38-year old unvaccinated female, established on haemodialysis for 1 year, with underlying reflux nephropathy. Donor tested SARS-CoV-2 positive on polymerase chain reaction testing with a cycle threshold (CT) value of 29 initially. Sequential testing demonstrated a rise in CT value (37.8), aiding the decision to proceed. The recipient was high immunological risk and received a controlled category 3 donation after circulatory death (DCD) kidney transplant. She had immediate graft function and did not develop SARS-CoV-2 infection. Case 2: 63-year old female, with diabetes mellitus and hypertension. She was low immunological risk and for pre-emptive transplantation. The donor was SARS-CoV-2 positive with a CT value of 41.5 and was subsequently negative. Decision was made to proceed with a donation after brainstem death (DBD) transplant. The recipient had immediate graft function and did not develop SARS-CoV-2 infection. We report 2 cases of successful transplantation from SARS-CoV-2 positive donors, without severe infection, with no transmission seen in the recipients post-operatively. Decisions to proceed were primarily made on clinical grounds with assistance from RT-PCR CT values, making this a useful additional tool in determining suitability of organ donation in people who are SARS-CoV-2 positive.

A case of kidney transplantation for complete C4 deficiency with recurrent IgM-monoclonal gammopathy of renal significance (MGRS) associated nephropathy

We present a rare case of a patient with complete C4 deficiency who underwent kidney transplantation and experienced immunoglobulin M-monoclonalgammopathyofrenalsignificance (IgM-MGRS) recurrence after the procedure. A 45-year-old male patient presented with end-stage renal failure due to membranoproliferative glomerulonephritis (MPGN). The initial immunosuppressive regimen consisted of tacrolimus, steroids, mycophenolate mofetil, basiliximab, and rituximab. He underwent ABO-incompatible kidney transplantation from his mother in August 2021. The clinical course after kidney transplantation was uneventful for a month. A biopsy of the transplanted kidney was performed due to decreased renal function. The allograft biopsy result led to the suspicion of primary macroglobulinemia-associated nephropathy. Bone marrow biopsy revealed an increase in plasma cells; however, no diagnosis of primary macroglobulinemia was made. At this point, IgM-MGRS was diagnosed instead of primary macroglobulinemia. A follow-up allograft biopsy was performed, and IgM-MGRS-associated nephropathy was diagnosed. Eventually, his retrieved autologous kidney biopsy from the initial examination showed that the primary disease was not MPGN but recurrent IgM-MGRS-associated nephropathy. Dexamethasone, rituximab, and cyclophosphamide (DRC) were started to treat IgM-MGRS due to worsening renal function (serum creatinine levels were in the 4–5 mg/dL range). Additional doses of DRC with 20 cycles of plasma exchange were introduced. Severe side effects occurred but did not result in death.

First Multicenter Clinical Trial on Machine Perfusion Preservation for Marginal Donor Kidney Transplantation in Japan

Machine perfusion has not been widely used because of its low demand in Japan; however, we believe its advantages may increase the number of organ transplants. Here, we report the first clinical trial of machine perfusion for kidney transplantation in Japan. We used the CMP-X08 perfusion device (Chuo-Seiko Co, Ltd, Asahikawa, Hokkaido, Japan) to preserve the donated organs. The flow rate, perfusion pressure, renal resistance, and temperature were monitored during continuous hypothermic perfusion. From August 2020 to the present, 13 cases of perfusion-preserved kidney transplantation have been performed. Of these, ten and 3 cases were performed using organs donated after brain death (DBD) and cardiac death (DCD), respectively. The average age of the recipients was 55.9 ± 7.3 (45-66) years. The average dialysis period was 14.8 ± 8.4 (0-26) years. The donor's final creatinine level before organ retrieval was 1.58 ± 1.0 (0.46-3.07) mg/dL. The warm ischemic times of the 3 DCD donors were 3, 12, and 18 minutes. The average total ischemic time was 12.0 ± 3.7 (7.17-19.88) hours. The average MP time was 140 (60-240) minutes. A total of 7 cases had delayed graft function. The best creatinine level during hospitalization was 1.17 ± 0.43 (0.71-1.85) mg/dL. There were no primary non-functional cases, and perfusion preservation was safely performed in all cases. Therefore, we present this report as the first clinical trial on machine perfusion for kidney transplantation from marginal donors with DBD and DCD in Japan.

Upside-Down Kidney Transplantation in a Recipient with Severe Arteriosclerosis: A Case Report

Recently, the number of patients with significant arteriosclerosis has been increasing owing to the aging of kidney transplant patients, an increase in the number of patients with kidney failure with diabetes as the primary disease, and an increase in the number of patients undergoing long-term dialysis. Severe atherosclerosis in kidney transplant recipients makes it difficult to determine the site of vascular anastomosis and increases the technical difficulty of the surgical procedure. This study presents a case of upside-down kidney transplantation in a recipient with severe arteriosclerosis. The patient was a 58-year-old male with diabetic nephropathy. He received an ABO-compatible living donor kidney transplant from his wife. Preoperative computed tomography revealed a mild calcification of the external iliac artery. However, during surgery, more than half of the external iliac artery was found to be calcified, making vascular anastomosis difficult. The peripheral side of the external iliac artery showed mild atherosclerosis. Therefore, the vessel could be anastomosed to the peripheral side of the external iliac artery by turning the kidney graft upside-down for use as the anastomosis site. The postoperative course was uneventful, and the kidney function was good at the last follow-up. Upside-down kidney transplantation is safe in patients with severe arteriosclerosis.

Kidney transplantation in a patient with familial mediterranean fever complicated by secondary amyloidosis (clinical report)

The paper presents a clinical case of successful kidney transplantation (KTx) in a patient with end-stage chronic kidney disease (ESKD) resulting from familial Mediterranean fever (FMF). Pre-transplant preparation and posttransplant management tactics are presented. The authors conclude that ESKD can be effectively treated by KTx in a patient with FMF against the background of ongoing pathogenetic therapy in autoinflammation.

PD31-02 ROBOTIC ASSISTED KIDNEY TRANSPLANT STILL FAILING TO IMPRESS: A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023PD31-02 ROBOTIC ASSISTED KIDNEY TRANSPLANT STILL FAILING TO IMPRESS: A SYSTEMATIC REVIEW AND META-ANALYSIS Tuan Thanh Nguyen, Adnan El-Achkar, Berut Lebanon, Ho Yee Tiong, Ryan W. Dobbs, Huy Gia Vuong, Jacob Basilius, Le Quy Van Dinh, Ho Chi Minh, Vietnam, Jad Najdi, Trong Hieu Le, Tien-Dat Hoang, Khoa Quy, Ali Sohrab Naushad, Mohammed Shahait, Amman Jordan, and David I. Lee Tuan Thanh NguyenTuan Thanh Nguyen More articles by this author , Adnan El-AchkarAdnan El-Achkar More articles by this author , Berut LebanonBerut Lebanon More articles by this author , Ho Yee TiongHo Yee Tiong More articles by this author , Ryan W. DobbsRyan W. Dobbs More articles by this author , Huy Gia VuongHuy Gia Vuong More articles by this author , Jacob BasiliusJacob Basilius More articles by this author , Le Quy Van DinhLe Quy Van Dinh More articles by this author , Ho Chi MinhHo Chi Minh More articles by this author , Vietnam Vietnam More articles by this author , Jad NajdiJad Najdi More articles by this author , Trong Hieu LeTrong Hieu Le More articles by this author , Tien-Dat HoangTien-Dat Hoang More articles by this author , Khoa QuyKhoa Quy More articles by this author , Ali Sohrab NaushadAli Sohrab Naushad More articles by this author , Mohammed ShahaitMohammed Shahait More articles by this author , Amman JordanAmman Jordan More articles by this author , and David I. LeeDavid I. Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003324.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Several centers have reported their recent experiences with the robotic approach in kidney transplantation. Previous reports suggest lower incidence of incisional hernia and lymphocele. However, these reported improvements in perioperative and follow-up outcomes are still debated. This most comprehensive and updated meta-analysis sought to compare the perioperative and follow-up outcomes between robot-assisted kidney transplantation (RAKT) and open kidney transplantation (OKT). METHODS: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until May 21, 2022. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. The risk ratio (RR) and mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI). RESULTS: Of the 1580 retrieved abstracts, 95 underwent full-text review, and 15 studies were included in the final analysis, comprising a total cohort of 2,319 cases of kidney transplantation (667 RAKT and 1,652 OKT). The quality of the studies remains low with large heterogeneity in the cohorts. the RAKT group still has longer warm ischemia time, cold ischemia time, rewarming time, total ischemia time and operative time compared to the OKT group. Even though RAKT group had shorter incision length (RR=1.42, 95%CI (0.350 - 5.766), p=0.623) resulting in lower pain score (MD=-1.37, 95%CI (-1.59 - -1.15), p=<0.001), less morphine use (SMD=-3.478, 95%CI (-5.619 - -1.336), p=0.001), and shorter length of stay (LOS) (SMD=-0.496, 95%CI (-0.819 - -0.173), p=0.003), it has similar clinical estimated blood loss, similar rates of surgical site hernia and postoperative lymphocele. Both techniques have equivalent renal function, graft, and patient survival. Decrease surgical site infection remains only significant in obese patients. CONCLUSIONS: Our study showed that with a larger series and more patients, the initial promise that RAKT have lower rates rate of lymphocele incisional hernia is not true. While RKT does have shorter wound incision, less pain, and LOS, this comes at a cost of longer op times with no improvement in graft survival. The answer to whether RAKT is worthwhile remains to be answered by a randomized controlled study. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e900 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tuan Thanh Nguyen More articles by this author Adnan El-Achkar More articles by this author Berut Lebanon More articles by this author Ho Yee Tiong More articles by this author Ryan W. Dobbs More articles by this author Huy Gia Vuong More articles by this author Jacob Basilius More articles by this author Le Quy Van Dinh More articles by this author Ho Chi Minh More articles by this author Vietnam More articles by this author Jad Najdi More articles by this author Trong Hieu Le More articles by this author Tien-Dat Hoang More articles by this author Khoa Quy More articles by this author Ali Sohrab Naushad More articles by this author Mohammed Shahait More articles by this author Amman Jordan More articles by this author David I. Lee More articles by this author Expand All Advertisement PDF downloadLoading ...