Afferi Luca, Territo Angelo, Pecoraro Alessio, Masieri Lorenzo, Ortved Milla, Dagnæs-Hansen Julia Abildgaard, Etcheverry Begonya, Gallioli Andrea, Cannoletta Donato, Vangeneugden Joris, Mercier Jeremy, Prudhomme Thomas, Donnini Isacco, Vazzana Antonino, Rohrsted Malene, Vigués Francesc, Doumerc Nicolas, Decaestecker Karel, Palou Joan, Campi Riccardo, Serni Sergio, Roder Andreas, Breda Alberto
Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain.
Department of Urology, Fundació Puigvert, Barcelona, Spain.
BJU Int. 2025 Sep;136(3):484-492. doi: 10.1111/bju.16799. Epub 2025 May 26.
To test the hypothesis that the type of surgical approach, robot-assisted kidney transplantation (RAKT) vs open kidney transplantation (OKT), impacts intra-operative and postoperative surgical outcomes of patients receiving kidney transplantation from deceased donors.
This was a multicentre retrospective cohort study including 676 patients who received RAKT or OKT in the period 2015 to 2023 in one of seven European academic centres. Patient heterogeneity at baseline was balanced using 2:1 nearest neighbour propensity-score matching. Intra- and postoperative complications were reported according to the Clavien-Dindo classification system. Kaplan-Meier estimates and the log-rank test were used to compare dialysis-free survival (DFS), graft survival (GS), reintervention-free survival (RFS) and overall survival (OS) according to the surgical approach used.
After propensity-score matching, two cohorts of 72 recipients (65%) in the OKT group and 37 (35%) in the RAKT group with similar baseline characteristics were obtained. The site of transplantation was the right iliac fossa in 59 (82%) and 28 patients (76%) undergoing OKT and RAKT, respectively. RAKT was associated with shorter rewarming time (53 vs 39 min), total vascular anastomosis time (55 vs 36 min), and arterial (25 vs 17 min) and venous (28 vs 18 min) anastomosis times (all P < 0.001), whereas OKT was associated with reduced surgical time (180 vs 200 min; P = 0.01). Intra-operative complications were more commonly reported in recipients undergoing OKT (8.3% vs 2.7%; P = 0.4). During follow-up, no differences in terms of postoperative complications, DFS, GS, RFS or OS were detected.
This is the largest comparative study of RAKT vs OKT in the deceased donor setting. While it confirms the safety of RAKT from deceased donors, it underscores the superiority of RAKT in selected patients in terms of achieving vascular anastomosis and rewarming time in a shorter timeframe.
检验以下假设，即手术方式（机器人辅助肾移植[RAKT]与开放肾移植[OKT]）会影响接受 deceased 供体肾移植患者的术中及术后手术结局。
这是一项多中心回顾性队列研究，纳入了 2015 年至 2023 年期间在七个欧洲学术中心之一接受 RAKT 或 OKT 的 676 例患者。使用 2:1 最近邻倾向评分匹配来平衡基线时的患者异质性。根据 Clavien-Dindo 分类系统报告术中及术后并发症。使用 Kaplan-Meier 估计值和对数秩检验，根据所采用的手术方式比较无透析生存期（DFS）、移植物生存期（GS）、无再次干预生存期（RFS）和总生存期（OS）。
倾向评分匹配后，获得了两组基线特征相似的患者，OKT 组 72 例（65%），RAKT 组 37 例（35%）。接受 OKT 和 RAKT 的患者中，分别有 59 例（82%）和 28 例（76%）的移植部位为右髂窝。RAKT 与较短的复温时间（53 分钟对 39 分钟）、总血管吻合时间（55 分钟对 36 分钟）以及动脉（25 分钟对 17 分钟）和静脉（28 分钟对 18 分钟）吻合时间相关（均 P < 0.001），而 OKT 与手术时间缩短相关（180 分钟对 200 分钟；P = 0.01）。接受 OKT 的受者术中并发症报告更为常见（8.3%对 2.7%；P = 0.4）。在随访期间，未检测到术后并发症、DFS、GS、RFS 或 OS 方面的差异。
这是 deceased 供体情况下 RAKT 与 OKT 最大规模的比较研究。虽然它证实了 deceased 供体 RAKT 的安全性，但强调了 RAKT 在特定患者中在更短时间内实现血管吻合和复温时间方面的优越性。
