Open Kidney Transplantation Using Living Donor Kidneys Procured with Robotic Assistance

Background:Robotic-Assisted Living Donor Nephrectomy (RALDN) has been shown to be a safe and feasible option, offering enhanced visualization and improved surgical dexterity, allowing for a potential increase in the living donor pool to perform pediatric and adult kidney transplants, even in cases of grafts with anatomical variants.We report our recent experience in using RALDN for Open Kidney Transplantation (OKT).Materials and Methods:Between August 2021 and December 2024, 112 kidney transplant recipients underwent OKT using RALDN grafts obtained at our institution.Evaluated clinical outcomes during the first 12mo post-transplant included the incidence of Delayed Graft Function (DGF), surgical complications, estimated Glomerular Filtration Rate (eGFR), and graft loss.Results:There were 14 pediatric and 98 adult recipients.Median recipient and donor ages were 41.9yr and 39.0yr, respectively.Male recipients comprised 63.4% (71/112); female donors comprised 56.2% (63/112).Among donors, no conversion to open surgery was required, and no post-operative complications attributed to the RALDN procedure were observed.Twenty-eight kidney grafts required back-table reconstruction.Median cold and warm ischemia times were 54.5min and 26.0min, respectively.One case (0.8%) of DGF was observed.While there were no recipient post-operative vascular complications, 3.6% (4/112) developed a urologic complication.Mean eGFR at 1mo, 3mo, 6mo, 77.1, 75.4,and 73.6 ml/min/1.73m 2 , respectively.While no graft failures during the first 12mo post-transplant were observed, one patient died with a functioning graft. Conclusion:RALDN is a safe and effective technique that provides favorable outcomes among both donors and recipients; this minimally invasive approach should be offered as a safe alternative to living donor patients.