Robot-assisted kidney transplantation in living and deceased donors: a six-year experience

Robot-assisted kidney transplantation (RAKT) is increasingly adopted, but reports describing large-volume programs with predominantly deceased-donor transplantation, increasing procedural complexity, and experience across both single-port (SP) and multiport (MP) robotic platforms remain limited. In this retrospective, single-center study, we reviewed a prospectively maintained registry of patients who underwent RAKT between October 2019 and December 2025 and evaluated perioperative, postoperative, and allograft outcomes. A total of 228 patients underwent RAKT, including 125 (54.8%) deceased-donor kidney transplants (DDKT) and 103 (45.2%) living-donor kidney transplants (LDKT). SP and MP platforms were utilized in 30.7% and 69.3% of cases, respectively. Six patients received dual-kidney transplants and four underwent simultaneous kidney-pancreas transplantation. Annual case volume increased from one procedure in 2019 to 115 procedures in 2025. Median operative times were 3 h 38 min for DDKT and 4 h 6 min for LDKT, with median vascular anastomosis times of 44 and 40 min, respectively. Conversion to open surgery occurred in one patient (0.4%). Median length of stay was four days for DDKT and two days for LDKT. Delayed graft function occurred in 30.4% of DDKT recipients and 4.8% of LDKT recipients; among the 121 recipients with available one-year serum creatinine, median one-year serum creatinine was 1.49 mg/dL and 1.37 mg/dL, respectively. Graft-loss occurred in two DDKT recipients (1.6%) and one LDKT recipient (0.9%), while three deaths (2.4%) occurred after DDKT and one death (0.9%) after LDKT. In this large single-center experience, RAKT was associated with low conversion rates, favorable perioperative outcomes, and good one-year graft function despite increasing procedural complexity, supporting its continued expansion in appropriately selected patients.