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Robotic-assisted kidney transplantation in obese recipients compared to non-obese recipients: the European experience

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Abstract

Purpose

The main objective was to compare minor (Clavien I–II) and major (Clavien ≥ III) intra- and postoperative complications of living donor robotic assisted kidney transplantation (RAKT) in obese (≥ 30 kg/m2 BMI), overweight (< 30/ ≥ 25 kg/m2 BMI) and non-overweight recipients (< 25 kg/m2 BMI).

Methods

For the present retrospective study, we reviewed the multi-institutional ERUS-RAKT database to select consecutive living donor RAKT recipients. Functional outcomes, intra- and postoperative complications were compared between obese, overweight and non-overweight recipients.

Results

169 living donor RAKTs were performed, by 10 surgeons, from July 2015 to September 2018 in the 8 European centers. 32 (18.9%) recipients were obese, 66 (39.1%) were overweight and 71 (42.0%) were non-overweight. Mean follow-up was 1.2 years. There were no major intra-operative complications in either study group. Conversion to open surgery occurred in 1 obese recipient, in 2 overweight recipients and no conversion occurred in non-overweight recipients (p = 0.3). Minor and major postoperative complications rates were similar in the 3 groups. At one-year of follow-up, median eGFR was similar in all groups [54 (45–60) versus 57 (46–70) versus 63 (49–78) ml/min/1.73 m2 in obese, overweight and non-overweight recipient groups, respectively, p = 0.5]. Delayed graft function rate was similar in the 3 groups. Only the number of arteries was an independent predictive factor of suboptimal renal function at post-operative day 30 in the multivariate analysis.

Conclusion

RAKT in obese recipients is safe, compared to non-overweight recipients and yields very good function, when it performed at high-volume referral centers by highly trained transplant teams.

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Abbreviations

BMI:

Body Mass Index

CIT:

Cold ischemia time

DGF:

Delayed graft function

eGFR:

Estimated glomerular function rate

ERUS:

European robotic urological section

ESRD:

End-stage renal disease

Hb:

Hemoglobin

IDEAL:

Innovation, development, exploration, assessment, long-term study

KT:

Kidney transplantation

LSG:

Laparoscopic sleeve gastrectomy

MDRD:

Modified diet in renal disease

MRA:

Multiple renal arteries

OKT:

Open kidney transplantation

PE:

Pulmonary embolism

POD:

Post-operative day

RAKT:

Robotic assisted kidney transplantation

RT:

Rewarming time

SRA:

Single renal artery

VAS:

Visual Analog Scale

WIT:

Warm ischemia time

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Authors and Affiliations

  1. Department of Urology and Kidney Transplantation, University Hospital of Rangueil, Toulouse, France

    Thomas Prudhomme, Marine Lesourd, Mathieu Roumiguié, Federico Sallusto & Nicolas Doumerc

  2. Department of Urology, Clinique La Croix du Sud, Toulouse, France

    Jean Baptiste Beauval

  3. Department of Urology, Ghent University Hospital, Ghent, Belgium

    Karel Decaestecker

  4. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy

    Graziano Vignolini, Riccardo Campi & Sergio Serni

  5. Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain

    Angelo Territo, Luis Gausa & Alberto Breda

  6. Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey

    Volkan Tugcu & Selcuk Sahin

  7. Department of Urology, Hospital Clinic, Barcelona, Spain

    Antonio Alcaraz & Mireia Musquera

  8. Department of Urology, Saarland University, HomburgSaar, Germany

    Michael Stockle & Martin Janssen

  9. Department of Urology, Halle University Hospital (Saale), Halle, Germany

    Paolo Fornara & Nasreldin Mohammed

  10. Department of Nephrology and Organ Transplantation, University Hospital of Rangueil, Toulouse, France

    Arnaud Del Bello & Nassim Kamar

Authors
  1. Thomas Prudhomme
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  2. Jean Baptiste Beauval
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Contributions

TP and AB: protocol development, data collection, data analysis, manuscript writing; JBB: protocol development, data analysis, manuscript writing and editing; ML, MR, GV, RC, SS, AT, LG, VT, SS, AA, MM, MS, MJ, PF and NM: data collection, data analysis; KD: protocol development, data collection, data analysis; ADB: protocol development, data analysis, manuscript editing; NK and FS: protocol development, data analysis; ND: protocol development, data collection, data analysis, manuscript writing and editing.

Corresponding author

Correspondence to Thomas Prudhomme.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.”

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Prudhomme, T., Beauval, J.B., Lesourd, M. et al. Robotic-assisted kidney transplantation in obese recipients compared to non-obese recipients: the European experience. World J Urol 39, 1287–1298 (2021). https://doi.org/10.1007/s00345-020-03309-6

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