Living-donor kidney transplantation: comparison of robotic-assisted versus conventional open technique in obese recipients.

PURPOSE: The objective was to compare the intraoperative, postoperative and functional outcomes of obese recipients undergoing robot-assisted living donor kidney transplantation (RAKT) compared to conventional open kidney transplantation (OKT).

METHODS

A retrospective analysis of living donor’s kidney transplantation performed in a tertiary French academic center between January 2012 and January 2025 was performed. Only recipients who were obese (BMI ≥ 30 g/m2) at the time of transplantation were included.

RESULTS

A total of 86 patients were included in our study, including 46 patients in the RAKT group and 40 patients in the OKT group. The two groups were comparable except a higher rate of previous abdominal surgery in the OKT group (65% versus 28%; p = 0.001). Early postoperative complications and delayed graft function were similar between the 2 groups. One death occurred on postoperative day 15 in the OKT group due to cardiac arrest. Two open conversions occurred in the RAKT group: one due to active bleeding and one due to intraoperative venous thrombosis. Median length of hospitalization was significantly longer in the OKT group (12 versus 9 days, p = 0.001). The rate of surgical reintervention after POD 90 was significantly higher in the OKT group (37.5% versus 6.5%, p = 0.003). 1- and 3-patient and graft survival were comparable between the RAKT and OKT cohorts.

CONCLUSIONS

Our outcomes confirms the safety and efficacy of robotic approach for living donor kidney transplantation in obese recipients.