Robotic kidney transplantation with deceased donor grafts: a comparative analysis of outcomes following donation after brain death and donation after circulatory death.

Robotic kidney transplantation (RKT) has demonstrated favorable outcomes in living donor cases. However, evidence on its application using deceased donor grafts (dRKT) remains limited. We conducted a retrospective single-center analysis of RKT procedures performed at the University of Colorado Hospital between November 2021 and January 2026. Perioperative, postoperative, and functional outcomes were analyzed, with a sub-analysis comparing normothermic regional perfusion (NRP) and rapid recovery (RR) DCD techniques. A total of 69 dRKTs were performed, with 29 (42.0%) involving donation after brain death (DBD) and 40 (58.0%) from donation after circulatory death (DCD). No conversions to open surgery occurred. Operative parameters, blood loss, and hospital stay were comparable between DBD and DCD groups. Delayed graft function (DGF) occurred in 34.5% of DBD and 47.5% of DCD recipients (p = 0.404), with no significant differences in graft or patient survival. When comparing DCD NRP grafts to DCD RR grafts, the difference in DGF rates was not significant, and NRP and RR grafts had comparable graft and patient survival. Robotic kidney transplantation using deceased donor grafts appears technically feasible in selected DBD and DCD recipients at an experienced transplant center. Although outcome profiles may clinically differ between groups, these results did not meet statistical significance. Among DCD grafts, rates of DGF in NRP and RR cohorts were not statistically significant, a finding that should be considered exploratory.