Kiani Amen Z, Hill Angela L, Vachharajani Neeta, Davidson Jesse, Progar Kristin, Olumba Franklin, Yu Jennifer, Cullinan Darren, Martens Gregory, Lin Yiing, Chapman William C, Doyle Majella B, Wellen Jason R, Khan Adeel S
Section of Abdominal Transplant, Department of General Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA.
Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, 63110, USA.
Surg Endosc. 2025 Jan;39(1):448-458. doi: 10.1007/s00464-024-11301-z. Epub 2024 Oct 5.
Several studies have demonstrated the feasibility of robotic kidney transplant (RKT) as a safe alternative to open kidney transplant (OKT). However, significant selection bias in RKT patient selection limits meaningful comparison between the two techniques.
This is a single-center retrospective review of a prospectively maintained kidney transplant database (2021-2024). Outcomes after the first 50 "non-selected" RKTs are compared with a contemporary cohort of 100 OKTs after propensity score matching for age, gender, BMI and type of donation (living vs deceased). Data pertinent to recipient demographics, intraoperative parameters, and short-term post-operative outcomes were collected and compared.
Both groups were well-matched for recipient age, gender, BMI, and donation type. RKT group had significantly longer total operative time (RKT 258 min vs. OKT 183 min; p < 0.0001) and warm ischemia time (RKT 37 min vs. OKT 31 min; p < 0.0001) but significantly less blood loss (OKT 155 ml vs. RKT 93 ml). Average length of hospital stay for both groups was 5 days, with OKT group demonstrating significantly higher rates of post-operative complications (OKT 31% vs. RKT 14%; p = 0.028), return to OR (OKT 15% vs. RKT 2%; p = 0.021), hematoma (OKT 13% vs. RKT 2%; p = 0.0355), and lymphocele (OKT 25% vs. RKT 6%; p = 0.0039). OKT group also had higher 30-day readmission rate (OKT 31% vs. RKT 14%) and post-operative opioid requirement (OKT 93 MME vs. RKT 65; p = 0.0254). There were no differences in rates of wound infection, urine leaks, delayed graft function, acute rejection, graft loss, and patient death between the two groups.
RKT is a safe and viable alternative to OKT as a first-choice procedure for all patients with ESRD. RKT offers many advantages over OKT which can lead to its wider adoption in the coming years as the new standard of care for ESRD patients.
多项研究已证明机器人辅助肾移植（RKT）作为开放肾移植（OKT）的一种安全替代方案具有可行性。然而，RKT患者选择中存在的显著选择偏倚限制了这两种技术之间有意义的比较。
这是一项对前瞻性维护的肾移植数据库（2021 - 2024年）进行的单中心回顾性研究。将前50例“非选择性”RKT后的结果与100例OKT的当代队列进行比较，这些OKT在年龄、性别、体重指数和捐赠类型（活体捐赠与尸体捐赠）方面进行了倾向评分匹配。收集并比较了与受者人口统计学、术中参数和短期术后结果相关的数据。
两组在受者年龄、性别、体重指数和捐赠类型方面匹配良好。RKT组的总手术时间（RKT 258分钟 vs. OKT 183分钟；p < 0.0001）和热缺血时间（RKT 37分钟 vs. OKT 31分钟；p < 0.0001）显著更长，但失血量显著更少（OKT 155毫升 vs. RKT 93毫升）。两组的平均住院时间均为5天，OKT组术后并发症发生率显著更高（OKT 31% vs. RKT 14%；p = 0.028），返回手术室率（OKT 15% vs. RKT 2%；p = 0.021）、血肿发生率（OKT 13% vs. RKT 2%；p = 0.0355）和淋巴囊肿发生率（OKT 25% vs. RKT 6%；p = 0.0039）。OKT组的30天再入院率（OKT 31% vs. RKT 14%）和术后阿片类药物需求量也更高（OKT 93吗啡毫克当量 vs. RKT 65；p = 0.0254）。两组在伤口感染、尿漏、移植肾功能延迟、急性排斥反应、移植肾丢失和患者死亡发生率方面无差异。
对于所有终末期肾病（ESRD）患者，RKT作为首选手术是OKT的一种安全可行的替代方案。与OKT相比，RKT具有许多优势，这可能导致其在未来几年作为ESRD患者新的护理标准得到更广泛的应用。
