Abstract
OBJECTIVES: 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. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.