Robot-assisted Versus Open Kidney Transplantation from Living Donor

Area of Science:

• Nephrology
• Surgical Innovation
• Transplantation Medicine

Background:

• Limited evidence compares robot-assisted kidney transplantation (RAKT) with open kidney transplantation (OKT) in end-stage kidney disease (ESKD) patients.
• Need to evaluate RAKT's impact on renal function, perioperative complications, and long-term outcomes.

Purpose of the Study:

• Compare RAKT versus OKT in living donor kidney transplant recipients.
• Assess differences in early renal function, perioperative complications, and survival rates.

Main Methods:

• Multicenter retrospective study (June 2015-December 2023) in seven European centers.
• Propensity score matching (1:1) to balance baseline characteristics of 733 patients.
• Logistic and Cox regression for complications and reintervention; Kaplan-Meier for survival.

Main Results:

• Matched cohorts of 306 patients each (RAKT vs. OKT).
• RAKT showed reduced total vascular anastomosis time but longer surgical/rewarming times.
• RAKT significantly lowered early (<30 days) and severe (Clavien-Dindo ≥3) postoperative complications (29% vs. 42%) and reintervention risk (HR 0.38).

Conclusions:

• RAKT in experienced centers can decrease perioperative morbidity and reinterventions.
• RAKT does not compromise early renal function or long-term patient/graft survival.
• Further research needed on optimal patient subgroups, patient-reported outcomes, and cost-effectiveness.