机器人辅助与开放手术治疗 ABO 不相容肾移植结局的对比研究——倾向评分匹配分析：一项回顾性队列研究。
A comparative study on outcomes of ABO-incompatible kidney transplants between robot-assisted vs. open surgery-propensity score-matched analysis: a retrospective cohort study.
机构信息
Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
出版信息
BMC Nephrol. 2024 Nov 14;25(1):410. doi: 10.1186/s12882-024-03842-1.
BACKGROUND
Robot-assisted kidney transplantation (RAKT) is increasingly being adopted worldwide. Despite this growing interest, there remains a notable gap in the literature, especially concerning its effectiveness in immunologically high-risk patients compared to conventional open kidney transplantation (OKT). This study investigates the viability and success of RAKT in comparison with OKT, particularly for recipients with ABO incompatibility (ABOi).
METHODS
This retrospective, single-center study included 239 living-donor transplants between October 2020 and February 2023, with 210 patients undergoing ABOi-OKT and 29 undergoing ABOi-RAKT. A composite of biopsy-proven acute rejection (BPAR), graft failure, and the development of de novo donor-specific antibodies was analyzed through univariate and multivariate models. Propensity score matching (PSM) was utilized to ensure a balanced comparison between the two groups. Following PSM, a total of 131 cases in the OKT group and 26 cases in the RAKT group were analyzed.
RESULTS
After PSM, the mean recipient age was 48.56 years for OKT and 47.96 years for RAKT. Both groups had comparable one-year (RAKT: 92.4%, OKT: 93.1%) and two-year BPAR-free survival rates (RAKT: 92.4%, OKT: 91.9%). Mean estimated glomerular filtration rate values were similar at 12 months post-transplant (RAKT: 62.15 ml/min/1.73 m², OKT: 64.53 ml/min/1.73 m²). Operative times were significantly longer for RAKT (291.42 vs. 150.81 min, p < 0.001), while cold ischemic time was also longer for RAKT (119.77 vs. 47.22 min, p < 0.001). Hospital stays were shorter for RAKT (median 6 vs. 8 days, p < 0.001). There was no significant difference in the composite outcome of BPAR, graft failure, and de novo donor-specific antibodies between the two groups (HR 0.858, 95% CI: 0.180-4.096, p = 0.848).
CONCLUSIONS
RAKT is a safe and effective alternative to OKT in ABOi patients, demonstrating similar perioperative outcomes, graft survival rates, and renal function. The application of ropensity score matching analysis strengthens the reliability of these findings, confirming RAKT's viability for high-risk kidney transplant recipients.
TRIAL REGISTRATION
The clinical trial associated with this study was registered on 2024-02-24 with the Clinical Trial Number NCT06287008|| https://www.
CLINICALTRIALS
gov/ ).
背景
机器人辅助肾移植（RAKT）在全球范围内的应用日益增多。尽管人们对此越来越感兴趣，但在文献中仍存在明显的差距，特别是在与传统的开放性肾移植（OKT）相比时，RAKT 在免疫高风险患者中的效果。本研究旨在比较 RAKT 和 OKT 的可行性和成功率，特别是针对 ABO 不相容（ABOi）的受者。
方法
这是一项回顾性、单中心研究，纳入了 2020 年 10 月至 2023 年 2 月期间的 239 例活体供肾移植，其中 210 例接受了 ABOi-OKT，29 例接受了 ABOi-RAKT。通过单变量和多变量模型分析活检证实的急性排斥反应（BPAR）、移植物失败和新出现的供体特异性抗体的综合情况。采用倾向评分匹配（PSM）来确保两组之间的均衡比较。匹配后，OKT 组共有 131 例，RAKT 组共有 26 例。
结果
PSM 后，OKT 组的受者平均年龄为 48.56 岁，RAKT 组为 47.96 岁。两组的 1 年（RAKT：92.4%，OKT：93.1%）和 2 年 BPAR 无复发生存率相似。移植后 12 个月的估计肾小球滤过率（eGFR）值相似（RAKT：62.15ml/min/1.73m²，OKT：64.53ml/min/1.73m²）。RAKT 的手术时间明显更长（291.42 分钟 vs. 150.81 分钟，p<0.001），而 RAKT 的冷缺血时间也更长（119.77 分钟 vs. 47.22 分钟，p<0.001）。RAKT 的住院时间更短（中位数 6 天 vs. 8 天，p<0.001）。两组间 BPAR、移植物失败和新出现的供体特异性抗体的复合结果无显著差异（HR 0.858，95%CI：0.180-4.096，p=0.848）。
结论
在 ABOi 患者中，RAKT 是 OKT 的一种安全有效的替代方法，具有相似的围手术期结果、移植物存活率和肾功能。应用倾向评分匹配分析增强了这些发现的可靠性，证实了 RAKT 对高风险肾移植受者的可行性。
临床试验注册
本研究相关的临床试验于 2024 年 2 月 24 日在 ClinicalTrials.gov 上注册（注册号：NCT06287008）。
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