Living-donor kidney transplantation: comparison of robotic-assisted versus conventional open technique in obese recipients

The objective was to compare the intraoperative, postoperative and functional outcomes of obese recipients undergoing robot-assisted living donor kidney transplantation (RAKT) compared to conventional open kidney transplantation (OKT). A retrospective analysis of living donor’s kidney transplantation performed in a tertiary French academic center between January 2012 and January 2025 was performed. Only recipients who were obese (BMI ≥ 30 g/m2) at the time of transplantation were included. A total of 86 patients were included in our study, including 46 patients in the RAKT group and 40 patients in the OKT group. The two groups were comparable except a higher rate of previous abdominal surgery in the OKT group (65% versus 28%; p = 0.001). Early postoperative complications and delayed graft function were similar between the 2 groups. One death occurred on postoperative day 15 in the OKT group due to cardiac arrest. Two open conversions occurred in the RAKT group: one due to active bleeding and one due to intraoperative venous thrombosis. Median length of hospitalization was significantly longer in the OKT group (12 versus 9 days, p = 0.001). The rate of surgical reintervention after POD 90 was significantly higher in the OKT group (37.5% versus 6.5%, p = 0.003). 1- and 3-patient and graft survival were comparable between the RAKT and OKT cohorts. Our outcomes confirms the safety and efficacy of robotic approach for living donor kidney transplantation in obese recipients.