Robotic Versus Open Kidney Transplantation from Deceased Donors : A Prospective Observational Study
Campi, Riccardo (University of Florence. Department of Experimental and Clinical Medicine)
Pecoraro, A. (Unit of Urological Robotic Surgery and Renal Transplantation. University of Florence. Careggi Hospital)
Li Marzi, V. (Unit of Urological Robotic Surgery and Renal Transplantation. University of Florence. Careggi Hospital)
Tuccio, A. (Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology. University of Florence. Careggi Hospital)
Giancane, S. (Unit of Urological Robotic Surgery and Renal Transplantation. University of Florence. Careggi Hospital)
Peris, A. (Intensive Care Unit and Regional ECMO Referral Centre. Azienda Ospedaliero-Universitaria Careggi)
Cirami, C.L. (Nephrology. Dialysis and Transplantation Unit. Careggi University Hospital)
Breda, Alberto (Institut d'Investigació Biomèdica Sant Pau)
Vignolini, G. (Unit of Urological Robotic Surgery and Renal Transplantation. University of Florence. Careggi Hospital)
Serni, S. (European Association of Urology (EAU) Robotic Urology Section (ERUS)-Robot-assisted Kidney Transplantation (RAKT) Working Group)
Universitat Autònoma de Barcelona

Date:	2022
Abstract:	Background: While robot-assisted kidney transplantation (RAKT) from living donors has been shown to achieve favourable outcomes, there is a lack of evidence on the safety and efficacy of RAKT as compared with the gold standard open kidney transplantation (OKT) in the setting of deceased donors, who represent the source of most grafts worldwide. Objective: To compare the intraoperative, perioperative, and midterm outcomes of RAKT versus OKT from donors after brain death (DBDs). Design, setting, and participants: Data from consecutive patients undergoing RAKT or OKT from DBDs at a single academic centre between October 2017 and December 2020 were prospectively collected. Intervention: RAKT or OKT. Outcome measurements and statistical analysis: The primary outcomes were intraoperative adverse events, postoperative surgical complications, delayed graft function (DGF), and midterm functional outcomes. A multivariable logistic regression analysis assessed the independent predictors of DGF, trifecta, and suboptimal graft function (estimated glomerular filtration rate [eGFR] <45 ml/min/1. 73 m) at the last follow-up. Results and limitations: Overall, 138 patients were included (117 [84. 7%] OKTs and 21 [15. 3%] RAKTs). The yearly proportion of RAKT ranged between 10% and 18% during the study period. The OKT and RAKT cohorts were comparable regarding all graft-related characteristics, while they differed regarding a few donor- and recipient-related factors. The median second warm ischaemic time, ureterovesical anastomosis time, postoperative complication rate, and eGFR trajectories did not differ significantly between the groups. A higher proportion of patients undergoing OKT experienced DGF; yet, at a median follow-up of 31 mo (interquartile range 19-44), there was no difference between the groups regarding the dialysis-free and overall survival. At the multivariable analysis, donor- and/or recipient-related factors, but not the surgical approach, were independent predictors of DGF, trifecta, and suboptimal graft function at the last follow-up. The study is limited by its nonrandomised nature and the small sample size. Conclusions: Our study provides preliminary evidence supporting the noninferiority of RAKT from DBDs as compared with the gold standard OKT in carefully selected recipients. Patient summary: Kidney transplantation using kidneys from deceased donors is still being performed with an open surgical approach in most transplant centres worldwide. In fact, no study has compared the outcomes of open and minimally invasive (robotic) kidney transplantation from deceased donors. In this study, we evaluated whether robotic kidney transplantation using grafts from deceased donors was not inferior to open kidney transplantation regarding the intraoperative, postoperative, and midterm functional outcomes. We found that, in experienced hands and provided that there was a time-efficient organisation of the transplantation pathway, robotic kidney transplantation from deceased donors was feasible and achieved noninferior outcomes as compared with open kidney transplantation.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Complications ; Deceased donor ; Kidney ; Renal function ; Robotic ; Transplant
Published in:	European Urology Open Science, Vol. 39 (may 2022) , p. 36-46, ISSN 2666-1683

DOI: 10.1016/j.euros.2022.03.007
PMID: 35528789

11 p, 2.7 MB

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