Robotic-assisted kidney transplantation in obese recipients compared to non-obese recipients: the European experience

Abstract

Purpose

The main objective was to compare minor (Clavien I–II) and major (Clavien ≥ III) intra- and postoperative complications of living donor robotic assisted kidney transplantation (RAKT) in obese (≥ 30 kg/m2 BMI), overweight (< 30/ ≥ 25 kg/m2 BMI) and non-overweight recipients (< 25 kg/m2 BMI).

Methods

For the present retrospective study, we reviewed the multi-institutional ERUS-RAKT database to select consecutive living donor RAKT recipients. Functional outcomes, intra- and postoperative complications were compared between obese, overweight and non-overweight recipients.

Results

169 living donor RAKTs were performed, by 10 surgeons, from July 2015 to September 2018 in the 8 European centers. 32 (18.9%) recipients were obese, 66 (39.1%) were overweight and 71 (42.0%) were non-overweight. Mean follow-up was 1.2 years. There were no major intra-operative complications in either study group. Conversion to open surgery occurred in 1 obese recipient, in 2 overweight recipients and no conversion occurred in non-overweight recipients (p = 0.3). Minor and major postoperative complications rates were similar in the 3 groups. At one-year of follow-up, median eGFR was similar in all groups [54 (45–60) versus 57 (46–70) versus 63 (49–78) ml/min/1.73 m2 in obese, overweight and non-overweight recipient groups, respectively, p = 0.5]. Delayed graft function rate was similar in the 3 groups. Only the number of arteries was an independent predictive factor of suboptimal renal function at post-operative day 30 in the multivariate analysis.

Conclusion

RAKT in obese recipients is safe, compared to non-overweight recipients and yields very good function, when it performed at high-volume referral centers by highly trained transplant teams.

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Fig. 1
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Abbreviations

BMI:

Body Mass Index

CIT:

Cold ischemia time

DGF:

Delayed graft function

eGFR:

Estimated glomerular function rate

ERUS:

European robotic urological section

ESRD:

End-stage renal disease

Hb:

Hemoglobin

IDEAL:

Innovation, development, exploration, assessment, long-term study

KT:

Kidney transplantation

LSG:

Laparoscopic sleeve gastrectomy

MDRD:

Modified diet in renal disease

MRA:

Multiple renal arteries

OKT:

Open kidney transplantation

PE:

Pulmonary embolism

POD:

Post-operative day

RAKT:

Robotic assisted kidney transplantation

RT:

Rewarming time

SRA:

Single renal artery

VAS:

Visual Analog Scale

WIT:

Warm ischemia time

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Affiliations

Authors

Contributions

TP and AB: protocol development, data collection, data analysis, manuscript writing; JBB: protocol development, data analysis, manuscript writing and editing; ML, MR, GV, RC, SS, AT, LG, VT, SS, AA, MM, MS, MJ, PF and NM: data collection, data analysis; KD: protocol development, data collection, data analysis; ADB: protocol development, data analysis, manuscript editing; NK and FS: protocol development, data analysis; ND: protocol development, data collection, data analysis, manuscript writing and editing.

Corresponding author

Correspondence to Thomas Prudhomme.

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Prudhomme, T., Beauval, J.B., Lesourd, M. et al. Robotic-assisted kidney transplantation in obese recipients compared to non-obese recipients: the European experience. World J Urol (2020). https://doi.org/10.1007/s00345-020-03309-6

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Keyword

  • Obese patients
  • Kidney transplantation
  • Robot-assisted kidney transplantation
  • Robotic surgery
  • Vascular anastomosis