Robotic-assisted Versus Open Technique for Living Donor Kidney Transplantation: A comparison using propensity score matching for intention to treat

Background. Living donor robotic-assisted kidney transplantation (RAKT) is an alternative to open kidney transplantation (OKT), but experience with this technique is limited in the United States. Methods. A retrospective review of living donor kidney transplants performed between 2016 and 2018 compared RAKT with OKT with regard to recipient, donor, and perioperative parameters. A 1:1 propensity score matching was performed on recipient/donor age, sex, body mass index, race, preoperative dialysis, and calculated panel reactive antibodies. Results. Outcomes of patient survival, graft survival, and postoperative complications were assessed for 139 transplants (47 RAKT and 92 OKT). Propensity score analysis (47:47) showed that RAKT recipients had longer warm ischemic times (49 versus 40min; P<0.001) and less blood loss (100 versus 150mL; P=0.005). Operative time and length of stay were similar between groups. Postoperative serum creatinine was similar during a 2-y follow-up. Post hoc analysis excluding 4 open conversions showed lower operative time with RAKT (297 versus 320min; P=0.04) and lower 30-d (4.7% versus 23.4%; P=0.02) and 90-d (7% versus 27.7%; P=0.01) Clavien-Dindo grade ≥3 complications. Conclusions. Our findings suggest that RAKT is a safe alternative to OKT.