Robotic Kidney Transplantation With Grafts With Multiple Arteries: A Single-center Experience and Outcome Analysis

Although robotic kidney transplantation (RKT) is an emerging minimally invasive surgical technique, graft anatomical variations such as multiple renal arteries (MRAs) remain a perceived limitation to its broader dissemination. This study evaluates the feasibility and short-term outcomes of RKT in grafts with MRAs compared with single renal artery (SRA) grafts.

We conducted a retrospective review of RKT procedures performed at a single center from November 2021 to January 2026. Perioperative and postoperative outcomes were compared between MRA and SRA cohorts. A subanalysis was performed within the MRA group to assess the impact of single versus multiple arterial anastomoses. All RKTs were performed using the Da Vinci Xi system.

In the assessed period, 126 robotic-assisted kidney transplants were performed: 94 with SRA (74.6%) and 32 with MRAs (25.4%). Across the overall cohort, 1 patient (0.8%) had their operation converted to an open procedure. Total operative time had a median duration of 257 min (interquartile range [IQR], 213.0-309.8) in the SRA cohort compared with 303 min (IQR, 269.2-355.2) in the MRA cohort (P = 0.004). Warm ischemia time was measured at 34 min (IQR, 29.0-42.0) in the SRA group and at 40 min (IQR, 33.0-45.2) in the MRA group (P = 0.013). Within the MRA cohort, 9 grafts (28.1%) required a single arterial anastomosis (SAA) and 23 (71.9%) required multiple arterial anastomoses (MAA). The median operative time was 270 min (IQR, 210.0-305.0; SAA) versus 313 min (IQR, 283.5-392.5; MAA, P = 0.033). Warm ischemia time, anastomosis time, blood loss, length of stay, delayed graft function, serum creatinine at 1 mo, and graft survival did not differ between SAA and MAA cohorts.

RKT using grafts with MRAs is technically feasible and yields perioperative and short-term outcomes comparable with those of SRA grafts. The presence of MRAs should not be considered a contraindication to robotic transplantation.