Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois.
Department of Surgery, Tulane University, New Orleans, Louisiana.
Am J Transplant. 2020 Feb;20(2):430-440. doi: 10.1111/ajt.15626. Epub 2019 Dec 24.
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/m , 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.
尽管透析人群中的肥胖率不断上升，但许多中心仍拒绝为肥胖的肾移植候选人进行移植。我们对 2009 年 1 月至 2018 年 12 月期间的机器人辅助肾移植（RAKT）队列进行了单中心回顾性分析。这项分析共纳入了 239 名患者。中位 BMI 为 41.4kg/m，大多数（53.1%）患者为非裔美国人，69.4%的器官来源于活体供者。中位手术时间和热缺血时间分别为 4.8 小时和 45 分钟。有 3.8%的患者发生了伤口并发症（主要为血清肿和血肿），1 例患者发生了手术部位感染（SSI）。在随访期间，有 17 例（7.1%）移植失败，主要是由于急性排斥反应。患者生存率为 98%和 95%，而 1 年和 3 年时的移植物生存率分别为 98%和 93%。从 UNOS 数据库中同一时期接受开放移植的患者中获得了类似的生存统计数据。总之，RAKT 可以安全地用于肥胖患者，手术部位感染风险低，移植物功能良好，患者结局与全国数据相当。由于手术并发症发生率低，RAKT 可以改善肥胖患者接受肾移植的机会。
