National comparison of outcomes after robotic kidney transplantation and open kidney transplantation.

Kidney transplantation is the gold standard for end-stage renal disease, and robotic kidney transplant is becoming increasingly common globally. There have not been large-scale studies, however, assessing national outcomes of robotic kidney transplant compared to open kidney transplant. This was a retrospective cohort analysis of adults undergoing kidney-only transplant from the National Inpatient Sample, 2016–2022. Comparative analysis was performed using log-transformed linear regression for continuous variables and Rao-Scott chi-square testing for categorical variables. Rates of delayed graft function, length of stay, and costs were regressed on age, sex, race, primary payer, median household income, diabetes, obesity, hospital size, region, and calendar year. Of an estimated 140,495 kidney-only transplants, 670 (0.48%) were identified as robotic. In unadjusted analysis, recipients of robotic kidney transplant were less likely to have any kidney transplant complication (15.7% vs. 24.7%, p = 0.02) and less likely to experience surgical site infections or in-hospital death (p < 0.001). After adjustment, they were 64% less likely to have delayed graft function (adjusted odds ratio [aOR] 0.36, 95% confidence interval [CI] 0.17–0.80), similar length of stay (adjusted geometric mean ratio [aGMR] 1.01, 95% CI 0.91–1.11), but higher hospitalization costs (aGMR1.23, 95% CI 1.13–1.34). This study provides the first nationally representative evidence that robotic kidney transplantation is a viable alternative to open kidney transplantation. The robotic approach is associated with reduction in perioperative complications with higher hospitalization costs. These findings support the continued adoption of robotic techniques in kidney transplantation and serve as a resource for clinicians and policymakers.