Robot-assisted kidney transplantation for right versus left living donor kidneys: A single-center outcome and...

Robot-assisted kidney transplantation (RAKT) is the standard of care in experienced hands. Transplantation of right kidney (RK) from a living donor (LD) is challenging because the right renal vein is shorter and thinner, which can lead to underutilization of RKs from LD. Data for RK-RAKT are scarce. We aim to compare the surgical, peri-operative, and long-term outcomes after RAKT from RK donors versus left kidney (LK) donors and the learning curve (LC) for the entire RAKT cohort.

After ethical committee approval, we retrospectively analyzed 409 adult RAKTs from LDs performed by a single surgeon between 2013 and 2021. We compared donor/recipient demographics, intra-operative data, immediate and late graft function, and graft/patient survival.

Overall, 18.5% were RK-RAKT. Donor/recipient demographics were similar between the groups. Total vascular (32.9 ± 8.9 vs. 29.6 ± 5.8 min, P = 0.003) and venous anastomosis times (14.4 ± 6.1 vs. 11.4 ± 2.5 min, P < 0.0001) were significantly longer in the RK group. No significant differences were observed in the serum creatinine and estimated glomerular filtration rate levels at day 1 and 7; 1 month; 1, 3, 5, 7, 10 years. 10-year Death-censored graft survival (77.4% for left vs. 79.17% for right, P = 0.917) and patient survival (83.9% for left vs. 75% for right, P = 0.10) were comparable. LC was shorter for critical vascular steps and graft functional outcomes.

RK-RAKT achieves equivalent functional and survival outcomes to LK-RAKT. Concerns regarding vascular thrombosis are not supported by our findings. These results advocate for broader use of RK, potentially decreasing the wait times and improving the access to transplantation.