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Robotic kidney transplant has superior outcomes compared to open kidney transplant: results of a propensity match analysis

  • 2024 SAGES Oral
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Several studies have demonstrated the feasibility of robotic kidney transplant (RKT) as a safe alternative to open kidney transplant (OKT). However, significant selection bias in RKT patient selection limits meaningful comparison between the two techniques.

Methods

This is a single-center retrospective review of a prospectively maintained kidney transplant database (2021–2024). Outcomes after the first 50 “non-selected” RKTs are compared with a contemporary cohort of 100 OKTs after propensity score matching for age, gender, BMI and type of donation (living vs deceased). Data pertinent to recipient demographics, intraoperative parameters, and short-term post-operative outcomes were collected and compared.

Results

Both groups were well-matched for recipient age, gender, BMI, and donation type. RKT group had significantly longer total operative time (RKT 258 min vs. OKT 183 min; p < 0.0001) and warm ischemia time (RKT 37 min vs. OKT 31 min; p < 0.0001) but significantly less blood loss (OKT 155 ml vs. RKT 93 ml). Average length of hospital stay for both groups was 5 days, with OKT group demonstrating significantly higher rates of post-operative complications (OKT 31% vs. RKT 14%; p = 0.028), return to OR (OKT 15% vs. RKT 2%; p = 0.021), hematoma (OKT 13% vs. RKT 2%; p = 0.0355), and lymphocele (OKT 25% vs. RKT 6%; p = 0.0039). OKT group also had higher 30-day readmission rate (OKT 31% vs. RKT 14%) and post-operative opioid requirement (OKT 93 MME vs. RKT 65; p = 0.0254). There were no differences in rates of wound infection, urine leaks, delayed graft function, acute rejection, graft loss, and patient death between the two groups.

Conclusion

RKT is a safe and viable alternative to OKT as a first-choice procedure for all patients with ESRD. RKT offers many advantages over OKT which can lead to its wider adoption in the coming years as the new standard of care for ESRD patients.

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Abbreviations

BMI:

Body mass index

CIT:

Cold ischemia time

DBD:

Donation after brain death

DCD:

Donation after cardiac death

DGF:

Delayed graft function

EBL:

Estimated blood loss

ERAS:

Enhanced recovery after surgery

ESRD:

End-stage renal disease

IV:

Intravenous

KT:

Kidney transplantation

LOS:

Length of stay

MME:

Morphine milligram equivalents

OKT:

Open kidney transplant

PACU:

Post-anesthesia care unit

RKT:

Robotic kidney transplant

TOT:

Total operative time

WIT:

Warm ischemia time

References

  1. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK (1999) Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med 341:1725–1730

    Article  PubMed  CAS  Google Scholar 

  2. Kakaei F, Nikeghbalian S, Malek-hosseini S (2013) Kidney transplantation techniques. https://www.intechopen.com. https://doi.org/10.5772/54829

  3. Ahlawat R, Sood A, Jeong W, Ghosh P, Keeley J, Abdollah F, Kher V, Olson P, Farah G, Wurst H, Bhandari M, Menon M (2021) Robotic kidney transplantation with regional hypothermia versus open kidney transplantation for patients with end stage renal disease: an ideal stage 2B study. J Urol 205:595–602

    Article  PubMed  Google Scholar 

  4. Tzvetanov IG, Spaggiari M, Tulla KA, Di Bella C, Okoye O, Di Cocco P, Jeon H, Oberholzer J, Cristoforo Giulianotti P, Benedetti E (2020) Robotic kidney transplantation in the obese patient: 10-year experience from a single center. Am J Transpl 20:430–440

    Article  Google Scholar 

  5. Kishore TA, Kaddu DJ, Sodhi BS, Srinivasan SP, Unni NV (2024) Robotic kidney transplant beyond the learning curve: 8-year single-center experience and matched comparison with open kidney transplant. Urology 183:100–105

    Article  PubMed  Google Scholar 

  6. Breda A, Territo A, Gausa L, Tuğcu V, Alcaraz A, Musquera M, Decaestecker K, Desender L, Stockle M, Janssen M, Fornara P, Mohammed N, Siena G, Serni S, Guirado L, Facundo C, Doumerc N (2018) Robot-assisted kidney transplantation: the European experience. Eur Urol 73:273–281

    Article  PubMed  Google Scholar 

  7. Menon M, Sood A, Bhandari M, Kher V, Ghosh P, Abaza R, Jeong W, Ghani KR, Kumar RK, Modi P, Ahlawat R (2014) Robotic kidney transplantation with regional hypothermia: a step-by-step description of the Vattikuti Urology Institute-Medanta technique (IDEAL phase 2a). Eur Urol 65:991–1000

    Article  PubMed  Google Scholar 

  8. Lynch RJ, Ranney DN, Shijie C, Lee DS, Samala N, Englesbe MJ (2009) Obesity, surgical site infection, and outcome following renal transplantation. Ann Surg 250:1014–1020

    Article  PubMed  Google Scholar 

  9. Schweizer RT, Cho S, Koutz KOUNTZSL, Belzer FO (1972) Lymphoceles following renal transplantation. Arch Surg 104:42–45

    Article  PubMed  CAS  Google Scholar 

  10. Oberholzer J, Giulianotti P, Danielson KK, Spaggiari M, Bejarano-Pineda L, Bianco F, Tzvetanov I, Ayloo S, Jeon H, Garcia-Roca R, Thielke J, Tang I, Akkina S, Becker B, Kinzer K, Patel A, Benedetti E (2013) Minimally invasive robotic kidney transplantation for obese patients previously denied access to transplantation. Am J Transpl 13:721–728

    Article  CAS  Google Scholar 

  11. Campi R, Pecoraro A, Li Marzi V, Tuccio A, Giancane S, Peris A, Cirami CL, Breda A, Vignolini G, Serni S (2022) Robotic versus open kidney transplantation from deceased donors: a prospective observational study. Eur Urol Open Sci 39:36–46

    Article  PubMed  PubMed Central  Google Scholar 

  12. Garcia-Roca R, Garcia-Aroz S, Tzvetanov I, Jeon H, Oberholzer J, Benedetti E (2017) Single center experience with robotic kidney transplantation for recipients with BMI of 40 kg/m2 or greater: a comparison with the UNOS registry. Transplantation 101:191–196

    Article  PubMed  Google Scholar 

  13. Maheshwari R, Qadri SY, Rakhul LR, Chaturvedi S, Desai P, Grover R, Chhabra G, Khullar D, Kumar A (2020) Prospective nonrandomized comparison between open and robot-assisted kidney transplantation: analysis of midterm functional outcomes. J Endourol 34:939–945

    Article  PubMed  CAS  Google Scholar 

  14. Siedlecki A, Irish W, Brennan DC (2011) Delayed graft function in the kidney transplant. Am J Transplant 11:2279–2296

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  15. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  16. Dowell D, Haegerich TM, Chou R (2016) CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep 65:1–49

    Article  PubMed  Google Scholar 

  17. Hill AL, Scherer MD, Kiani A, Vachharajani N, Matson S, Cullinan DR, Martens GR, Yu J, Davidson JT, Wellen JR, Chapman WC, Doyle MB, Khan AS (2023) The impact of a dedicated operating room team on robotic transplant program growth and fellowship training. Clin Transpl 37:e15103

    Article  Google Scholar 

  18. Olumba FC, Vachharajani N, Yu J, Scherer M, Matson S, Hill AL, Kiani A, Lin Y, Doyle MMB, Chapman WC, Wellen JR, Khan AS (2023) Robotic donor nephrectomy: optimizing outcomes beyond the limitations of laparoscopy. Surg Endosc 37:7511–7519

    Article  PubMed  Google Scholar 

  19. Tzvetanov I, D’Amico G, Benedetti E (2015) Robotic-assisted kidney transplantation: our experience and literature review. Curr Transpl Rep 2:122–126

    Article  PubMed  Google Scholar 

  20. Kiani AZ, Progar K, Hill AL, Vachharajani N, Olumba F, Yu J, Chapman WC, Doyle MB, Wellen JR, Khan AS (2024) Robotic living donor nephrectomy is associated with reduced post-operative opioid use compared to hand-assisted laparoscopic approach. Surg Endosc 38:3654–3660

    Article  PubMed  Google Scholar 

  21. Modi P, Pal B, Modi J, Kumar S, Sood A, Menon M (2014) Robotic assisted kidney transplantation. Indian J Urol 30:287–292

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This paper was not funded through any grants.

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Authors and Affiliations

  1. Section of Abdominal Transplant, Department of General Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA

    Amen Z. Kiani, Angela L. Hill, Neeta Vachharajani, Jesse Davidson, Franklin Olumba, Jennifer Yu, Darren Cullinan, Gregory Martens, Yiing Lin, William C. Chapman, Majella B. Doyle, Jason R. Wellen & Adeel S. Khan

  2. Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, 63110, USA

    Kristin Progar

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  1. Amen Z. Kiani
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Correspondence to Amen Z. Kiani.

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Disclosures

Adeel Khan, MD and Jason Wellen MD are proctors for Intuitive Surgical. The remaining authors Amen Kiani, Angela Hill, Neeta Vachharajani, Franklin Olumba, Kristin Progar, Jesse Davidson, Jennifer Yu, Darren Cullinan, Gregory Martens, Yiing Lin, William Chapman, and Majella Doyle have no conflicts of interest or financial ties to disclose.

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Kiani, A.Z., Hill, A.L., Vachharajani, N. et al. Robotic kidney transplant has superior outcomes compared to open kidney transplant: results of a propensity match analysis. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-11301-z

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