Robot-assisted vs open kidney transplantation from deceased donors
Por:
Afferi, L, Territo, A, Pecoraro, A, Masieri, L, Ortved, M, Dagnaes-Hansen, JA, Etcheverry, B, Gallioli, A, Cannoletta, D, Vangeneugden, J, Mercier, J, Prudhomme, T, Donnini, I, Vazzana, A, Rohrsted, M, Vigues, F, Doumerc, N, Decaestecker, K, Palou, J, Campi, R, Serni, S, Roder, A, Breda, A
Publicada:
1 sep 2025
Ahead of Print:
1 may 2025
Resumen:
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.
Filiaciones:
Afferi, L:
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Luzerner Kantonsspital, Dept Urol, Luzern, Switzerland
Territo, A:
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Pecoraro, A:
Univ Florence, Dept Expt & Clin Med, Unit Oncol, Florence, Italy
Univ Florence, Careggi Hosp, Unit Urol Robot Surg & Renal Transplantat, Florence, Italy
Masieri, L:
Univ Florence, Dept Expt & Clin Med, Unit Oncol, Florence, Italy
Univ Florence, Careggi Hosp, Unit Urol Robot Surg & Renal Transplantat, Florence, Italy
Ortved, M:
Rigshosp, Urol Res Unit, Copenhagen, Denmark
Dagnaes-Hansen, JA:
Rigshosp, Urol Res Unit, Copenhagen, Denmark
Etcheverry, B:
Hosp Bellvitge Princeps Espanya, Dept Urol, Barcelona, Spain
Gallioli, A:
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Cannoletta, D:
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
IRCCS San Raffaele Sci Inst, Urol Res Inst, Div Oncol, Soldera Prostate Canc Lab,Unit Urol, Milan, Italy
Vangeneugden, J:
Ghent Univ Hosp, Dept Urol, Ghent, Belgium
AZ Maria Middelares, Ghent, Belgium
Univ Ghent, Fac Med & Hlth Sci, Dept Human Struct & Repair, Ghent, Belgium
Mercier, J:
Hosp Toulouse, Dept Urol, Toulouse, France
Prudhomme, T:
Hosp Toulouse, Dept Urol, Toulouse, France
Donnini, I:
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Vazzana, A:
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Rohrsted, M:
Rigshosp, Urol Res Unit, Copenhagen, Denmark
Vigues, F:
Hosp Bellvitge Princeps Espanya, Dept Urol, Barcelona, Spain
Doumerc, N:
Hosp Toulouse, Dept Urol, Toulouse, France
Decaestecker, K:
Ghent Univ Hosp, Dept Urol, Ghent, Belgium
AZ Maria Middelares, Ghent, Belgium
Univ Ghent, Fac Med & Hlth Sci, Dept Human Struct & Repair, Ghent, Belgium
Palou, J:
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Campi, R:
Univ Florence, Dept Expt & Clin Med, Unit Oncol, Florence, Italy
Univ Florence, Careggi Hosp, Unit Urol Robot Surg & Renal Transplantat, Florence, Italy
Serni, S:
Univ Florence, Dept Expt & Clin Med, Unit Oncol, Florence, Italy
Univ Florence, Careggi Hosp, Unit Urol Robot Surg & Renal Transplantat, Florence, Italy
Roder, A:
Rigshosp, Urol Res Unit, Copenhagen, Denmark
Breda, A:
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Green Submitted, hybrid
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