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Comparative Study
. 2025 Jan;39(1):448-458.
doi: 10.1007/s00464-024-11301-z. Epub 2024 Oct 5.

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

Amen Z Kiani  1 , Angela L Hill  2 , Neeta Vachharajani  2 , Jesse Davidson  2 , Kristin Progar  3 , Franklin Olumba  2 , Jennifer Yu  2 , Darren Cullinan  2 , Gregory Martens  2 , Yiing Lin  2 , William C Chapman  2 , Majella B Doyle  2 , Jason R Wellen  2 , Adeel S Khan  2
Affiliations
Comparative Study

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

Amen Z Kiani et al. Surg Endosc. 2025 Jan.

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.

Keywords: Kidney transplantation; Robot-assisted transplant; Robotic kidney transplant; Robotic surgery; Robotic transplant.

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Conflict of interest statement

Declarations. 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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