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

Abstract

Robot-assisted kidney transplantation (RAKT) is increasingly being adopted worldwide. Despite this growing interest, there remains a notable gap in the literature, especially concerning its effectiveness in immunologically high-risk patients compared to the conventional open kidney transplantation (OKT). This study is focused on exploring the viability and success of RAKT in comparison with OKT, particularly for recipients with ABO incompatibility (ABOi). A retrospective analysis was conducted on 239 living-donor transplants at a single center, comprising 210 OKT and 29 RAKT cases. Perioperative outcomes, graft survival, and renal function were assessed. A composite of biopsy-proven acute rejection (BPAR), graft failure, and the development of de novo donor-specific antibodies (DSA) was analyzed through univariate and multivariate models. Both RAKT and OKT groups showed comparable one and two-year BPAR-free survival rates (RAKT: 92.4%, OKT: 93.1% and 91.9% respectively) and similar mean eGFR values (RAKT: 64.41 ml/min/1.73m², OKT: 65.75 ml/min/1.73m²). OKT had a significantly shorter cold ischemic time and operative time but longer hospital stays compared to RAKT. Univariate and multivariate analyses indicate no significant difference in the composite outcome (BPAR, graft failure, de novo DSA) between the two groups. RAKT presents as a safe and effective alternative to OKT in ABOi patients, with similar perioperative outcomes, graft survival rate, and renal function.