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Prospective comparative study of postoperative systemic inflammatory syndrome in robot-assisted vs. open kidney transplantation

Abstract

Purpose

Robot-assisted kidney transplant (RAKT) recently proved to provide functional results similar to the preferred open kidney transplant (OKT), but with inferior wound morbidity. In a comparative prospective study, we explored the systemic inflammatory response syndrome (SIRS) after KT and compared OKT with RAKT.

Methods

Forty-nine patients underwent pre-emptive ABO-compatible kidney transplantations (KT) between January 2017 and December 2018 in 2 centers: 25 RAKT, 24 OKT. Postoperative SIRS was biologically assessed by serum markers (NGAL, CRP and IL-6) measured at: T0 (preoperative/baseline), T1(H1), T2(H6), T3(H12), T4(H24), T5(D2), T6(D3) and T7(D5) after KT.

Results

Inflammatory markers + eGFR were assessed in OKT vs. RAKT. IL-6 peak value occurred at H6 and reached ×9 from baseline. CRP peak occurred at H24 and reached ×28 from baseline (All P < 0.05). NGAL decreased after surgery with a plateau (divided by 2 from baseline) from H12 to D5. There was no significant difference in IL-6, CRP and NGAL kinetics and peak values between RAKT and OKT (All P > 0.05). Serum creatinine and eGFR on postoperative days 1, 3 and 7 were similar in RAKT and OKT (All P > 0.05). Delayed graft function was not observed.

Conclusion

In this exploratory study, the biological evaluation of postoperative SIRS after living-donor kidney transplant revealed no significant difference between OKT and RAKT and similar functional outcomes in the short term. These results highlight the safety of RAKT as an alternative to OKT in this setting.

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Fig. 1

Abbreviations

KT:

Kidney transplantation

RAKT:

Robot-assisted kidney transplantation

OKT:

Open kidney transplantation

SIRS:

Systemic inflammatory response syndrome

NGAL:

Neutrophil gelatinase-associated lipocalin

CRP:

C-reactive protein

IL-6:

Interleukin 6

eGFR:

Estimated glomerular filtration rate

EDTA:

Ethylene diamine tetra-acetic acid

CARS:

Compensatory anti-inflammatory response syndrome

MODS:

Multiple organ dysfunction syndrome

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Acknowledgements

We are grateful to Dr. S. Mateu (clinical research coordinator at Fundaciò Puigvert) for institutional review board approval and the European Association of Urology Scholarship Program (EUSP) to support this study.

Funding

Angelo Territo, Federica Regis and Romain Boissier received grants from the European Urology Scholarship Program (EUSP) for 1 year scholarships, respectively, from December 2016 to December 2017, January 2018 to December 2018, and September 2018 to August 2019, at Fundació Puigvert (Barcelona, Spain) where this study was conducted.

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Authors

Contributions

AT, RB and AB had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: AT, AB. Acquisition of data: RB, AT, JDS, GT, LG, FR, AG, NM, PF, LG. Analysis and interpretation of data: RB, AT JDS, Theil, IM, LG, Mohammed. Drafting of the manuscript: RB, AT, JDS, AB. Critical revision of the manuscript for important intellectual content: AB. Statistical analysis: RB, JDS. Funding: EAU Scholarship Program Grants. Administrative, technical, or material support: PF, LG, AB. Supervision: PF, AB.

Corresponding author

Correspondence to Romain Boissier.

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All authors certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None.

Research involving human participants and/or animals

The study adhered to the tenets of the Declaration of Helsinki. The study was approved by the ethics committee of Fundació Puigvert. The study also guaranteed compliance at all times with Law 15/1999 for the Protection of Personal Data (Spanish Government).

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Informed consent was obtained from all patients prior to inclusion in the study.

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Territo, A., Boissier, R., Subiela, J.D. et al. Prospective comparative study of postoperative systemic inflammatory syndrome in robot-assisted vs. open kidney transplantation. World J Urol (2021). https://doi.org/10.1007/s00345-021-03836-w

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Keywords

  • Kidney transplant
  • Robot-assisted kidney transplantation
  • Open kidney transplantation
  • Inflammatory biomarkers