Prudhomme Thomas, Beauval Jean Baptiste, Lesourd Marine, Roumiguié Mathieu, Decaestecker Karel, Vignolini Graziano, Campi Riccardo, Serni Sergio, Territo Angelo, Gausa Luis, Tugcu Volkan, Sahin Selcuk, Alcaraz Antonio, Musquera Mireia, Stockle Michael, Janssen Martin, Fornara Paolo, Mohammed Nasreldin, Del Bello Arnaud, Kamar Nassim, Sallusto Federico, Breda Alberto, Doumerc Nicolas
Department of Urology and Kidney Transplantation, University Hospital of Rangueil, Toulouse, France.
Department of Urology, Clinique La Croix du Sud, Toulouse, France.
World J Urol. 2021 Apr;39(4):1287-1298. doi: 10.1007/s00345-020-03309-6. Epub 2020 Jun 19.
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/m BMI), overweight (< 30/ ≥ 25 kg/m BMI) and non-overweight recipients (< 25 kg/m BMI).
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.
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 m 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.
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.
主要目的是比较肥胖（体重指数≥30kg/m²）、超重（体重指数<30/≥25kg/m²）和非超重受者（体重指数<25kg/m²）在活体供体机器人辅助肾移植（RAKT）术中及术后的轻微（Clavien I-II级）和严重（Clavien≥III级）并发症。
在本回顾性研究中，我们查阅了多机构的ERUS-RAKT数据库，以选择连续的活体供体RAKT受者。比较肥胖、超重和非超重受者的功能结局、术中及术后并发症。
2015年7月至2018年9月，8个欧洲中心的10位外科医生共进行了169例活体供体RAKT手术。32例（18.9%）受者肥胖，66例（39.1%）超重，71例（42.0%）非超重。平均随访时间为1.2年。两个研究组术中均未发生严重并发症。1例肥胖受者、2例超重受者转为开放手术，非超重受者无转为开放手术者（p=0.3）。三组术后轻微和严重并发症发生率相似。随访1年时，所有组中位估算肾小球滤过率相似[肥胖、超重和非超重受者组分别为54（45-60）对57（46-70）对63（49-78）ml/min/1.73m²，p=0.5]。三组移植肾功能延迟发生率相似。多因素分析中，仅动脉数量是术后第30天肾功能欠佳的独立预测因素。
与非超重受者相比，肥胖受者接受RAKT手术是安全的，且当由训练有素的移植团队在大容量转诊中心进行时，移植肾功能良好。
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