Robotic kidney transplantation in the obese patient: 10-year experience from a single center

Abstract

Despite increasing obesity rates in the dialysis population, obese kidney transplant candidates are still denied transplantation by many centers. We performed a single‐center retrospective analysis of a robotic‐assisted kidney transplant (RAKT) cohort from January 2009 to December 2018. A total of 239 patients were included in this analysis. The median BMI was 41.4 kg/m2, with the majority (53.1%) of patients being African American and 69.4% of organs sourced from living donors. The median surgery duration and warm ischemia times were 4.8 hours and 45 minutes respectively. Wound complications (mostly seromas and hematomas) occurred in 3.8% of patients, with 1 patient developing a surgical site infection (SSI). Seventeen (7.1%) graft failures, mostly due to acute rejection, were reported during follow‐up. Patient survival was 98% and 95%, whereas graft survival was 98% and 93%, at 1 and 3 years respectively. Similar survival statistics were obtained from patients undergoing open transplant over the same time period from the UNOS database. In conclusion, RAKT can be safely performed in obese patients with minimal SSI risk, excellent graft function, and patient outcomes comparable to national data. RAKT could improve access to kidney transplantation in obese patients due to the low surgical complication rate.

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

“…Our survivals were similar with graft survival reported by Tzvetanov et al (9) (98% at 1 year) and Territo et al (8) (98% at 1 year). Moreover, our median operative time in the ABOi and ABOc-RAKT groups (130 and 150 min) were shorter than those reported by Tzvetanov et al (9) (289 min) and Territo et al (8) (300 min), as was our rewarming time [30 and 40 min in the ABOi and ABOc-RAKT groups vs. 45 min reported by (9) and 60 min reported by (8)].…”

“…In recent years, robotic-assisted kidney transplantation (RAKT) has been developed to reduce the surgical morbidity of KT. Thus, the feasibility, reproducibility, and safety of RAKT has been confirmed when performed by skilled robotic surgeons (8,9).…”

“…Recently, Tzvetanov et al (9), from the University of Illinois at Chicago group, reported their 10 years' experience of RAKT in obese patients. A total of 239 RAKT were performed with median BMI of 41.4 kg/m 2 .…”

The University of Florence Technique for Robot-Assisted Kidney Transplantation: 3-Year Experience

“…To date, most groups performing RAKT replicated the Vattikuti-Medanta technique (1). Nevertheless, specific modifications have been proposed by several teams to adapt the technique to the availability of surgical instrumentation, logistical issues, and surgeon's preference during the learning curve (4)(5)(6)(7). Moreover, our group reported for the first time the feasibility and safety of a structured RAKT program from deceased donors (DDs) (4).…”

Robotic Surgery for Obese Patients

“…Recently, Ivo G. Tzvetanov, MD, chief of the division of transplantation at University of Illinois (UI) Health in Chicago, and colleagues published their findings from a single‐center retrospective analysis of robotic‐assisted kidney transplant (RAKT) 3. Theirs was the first center to perform RAKT on obese patients, and they have accumulated 10 years’ of experience working with approximately 300 patients.…”