ABO-Incompatible Robotic-Assisted Kidney Transplantation in the Obese Recipient

Abstract

The objective of this preliminary study was to report and compare the peri-operative and functional results of ABO-incompatible (ABOi) living-donor roboticassisted kidney transplantation (RAKT), ABO-compatible (ABOc) living-donor RAKT, and ABOi living-donor open kidney transplantation (OKT). Materials and Methods: For the present retrospective study, we analyzed data of consecutive patients who underwent ABOi or ABOc-RAKT and ABOi-OKT, from January 2015 to December 2019, in one French academic center. Patients' baseline characteristics, operative, and functional outcomes were compared between ABOi-RAKT, ABOc-RAKT, and ABOi-OKT. Results: 29 RAKT, including 7 ABOi-RAKT, and 56 ABOi-OKT were performed in our center. Median follow-up was 2.0 years. Median recipient age, pre-emptive kidney transplantation rate, sex ratio and desensitization procedures were similar in ABOi-RAKT, ABOc-RAKT, and ABOi-OKT groups. Recipient BMI at transplantation was statistically higher in ABOi and ABOc-RAKT groups compared to ABOi-OKT. The surgical site complication (principally infection-related) rate was lower in ABOi-RAKT, without statistical differences (0 vs. 8.9%, respectively, in ABOi-RAKT and ABOi-OKT, p = 0.7). The delayed graft function rate was 0% in ABOi-RAKT, 13.6% in ABOc-RAKT, and 10.7% in ABOi-OKT (p = 0.6). The post-transplantation blood transfusion rate was statistically higher in the ABOi-OKT group (14.3 vs. 13.6 vs. 57.1% in ABOi-RAKT, ABOc-RAKT, and ABOi-OKT, respectively, p = 0.001). The kidney graft survival at 1 month and at last follow-up was not different between ABOi-RAKT and ABOi-OKT. Conclusion: Our data support the use of ABOi-RAKT to restore accessibility to kidney transplantation for obese patients to the greatest extent possible. Large series are required to confirm these encouraging data from a single center.

Comparison of clinical outcomes between robot-assisted and open ABO-incompatible kidney transplantation

“…Additionally, the ABOi-RAKT group showed a 0% rate of delayed graft function, compared to 10.7% in ABOi-OKT (p = 0.60), with similar graft survival rates observed in both groups [9].…”

“…The study highlighted the bene ts of RAKT for this group, such as improved surgical visibility, lower infection rates, reduced wound complications, and less lymphocele formation compared to OKT. The ndings indicated no signi cant difference in kidney graft survival rates two years post-transplant between the ABOi-RAKT and ABOi-OKT groups [9].…”