Robot-assisted kidney transplantation for right versus left living donor kidneys: A single-center outcome and learning curve analysis

ABSTRACT Introduction: Robot-assisted kidney transplantation (RAKT) is the standard of care in experienced hands. Transplantation of right kidney (RK) from a living donor (LD) is challenging because the right renal vein is shorter and thinner, which can lead to underutilization of RKs from LD. Data for RK-RAKT are scarce. We aim to compare the surgical, peri-operative, and long-term outcomes after RAKT from RK donors versus left kidney (LK) donors and the learning curve (LC) for the entire RAKT cohort. Methods: After ethical committee approval, we retrospectively analyzed 409 adult RAKTs from LDs performed by a single surgeon between 2013 and 2021. We compared donor/recipient demographics, intra-operative data, immediate and late graft function, and graft/patient survival. Results: Overall, 18.5% were RK-RAKT. Donor/recipient demographics were similar between the groups. Total vascular (32.9 ± 8.9 vs. 29.6 ± 5.8 min, P = 0.003) and venous anastomosis times (14.4 ± 6.1 vs. 11.4 ± 2.5 min, P < 0.0001) were significantly longer in the RK group. No significant differences were observed in the serum creatinine and estimated glomerular filtration rate levels at day 1 and 7; 1 month; 1, 3, 5, 7, 10 years. 10-year Death-censored graft survival (77.4% for left vs. 79.17% for right, P = 0.917) and patient survival (83.9% for left vs. 75% for right, P = 0.10) were comparable. LC was shorter for critical vascular steps and graft functional outcomes. Conclusions: RK-RAKT achieves equivalent functional and survival outcomes to LK-RAKT. Concerns regarding vascular thrombosis are not supported by our findings. These results advocate for broader use of RK, potentially decreasing the wait times and improving the access to transplantation.