Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Department of Surgery, University of Illinois at Chicago, Chicago, Illinois, USA.
Am J Transplant. 2023 May;23(5):642-648. doi: 10.1016/j.ajt.2023.02.016. Epub 2023 Feb 10.
Robotic-assisted kidney transplant (RAKT) has proven to be a successful approach for patients with elevated body mass index (BMI). To date, a paucity of studies comprehensively analyzing the clinical outcomes of RAKT by using the grafts from deceased donors exists. This was a single-center retrospective analysis of RAKT from deceased donor kidneys (n = 93) from 2009 to 2021. The cohort was divided into 3 groups on the basis of recipient BMI (BMI ≤ 41.2 vs BMI 41.2-44.5 vs BMI ≥ 44.5 kg/m, n = 31). Delayed graft function was significantly higher in the group with the highest BMI (BMI ≤ 41.2 vs BMI 41.2-44.5 vs BMI ≥ 44.5 kg/m, 12.5% vs 10% vs 45.16%, P = .001). Graft survival after 12 months of follow-up was significantly lower in the group with BMI of ≥44.5 kg/m (BMI ≤ 41.2 vs BMI 41.2-44.5 vs BMI ≥ 44.5 kg/m, 93.7% vs 100% vs 83.9%. P = .05). For BMI, the relative risk of patient survival was 1.10 for each increase in a BMI in the range of 5 (CI 95%, 0.98-1.21). Death-censored graft survival after 5 years was significantly better than the UNOS-matched cohort (dRAKT vs match, 86.2% vs 68.9%, P = .03). This single-center analysis shows that RAKT can be performed safely; however, caution should be used when matching marginal kidneys with patients with high BMI.
机器人辅助肾移植（RAKT）已被证明是治疗肥胖患者的一种成功方法。迄今为止，用尸体供肾进行 RAKT 的临床结果综合分析的研究很少。这是一项回顾性单中心研究，纳入了 2009 年至 2021 年期间的 93 例 RAKT 患者，这些患者的供肾均来自尸体供者。根据受者 BMI 将患者分为 3 组（BMI≤41.2、BMI 41.2-44.5、BMI≥44.5kg/m2，n=31）。在 BMI 最高的组中，延迟性肾功能恢复的发生率明显更高（BMI≤41.2、BMI 41.2-44.5、BMI≥44.5kg/m2，12.5%、10%、45.16%，P=0.001）。在 12 个月的随访后，BMI≥44.5kg/m2 组的移植物存活率明显较低（BMI≤41.2、BMI 41.2-44.5、BMI≥44.5kg/m2，93.7%、100%、83.9%，P=0.05）。对于 BMI，BMI 每增加 5 时，患者生存率的相对风险为 1.10（95%CI 98-1.21）。5 年后，死亡风险校正的移植物存活率明显优于 UNOS 匹配队列（dRAKT 与匹配组，86.2%与 68.9%，P=0.03）。这项单中心研究表明，RAKT 可以安全进行；然而，当为 BMI 较高的患者匹配边缘供肾时应谨慎。
