Robotic-Assisted vs Open Kidney Transplantation: A Propensity Matched Analysis

BACKGROUND Kidney transplantation, the primary treatment for ESRD, has evolved since 1956. This study evaluates the clinical outcomes of robotic-assisted kidney transplantation (RAKT) and open kidney transplantation (OKT), highlighting RAKT's benefits in magnification, ergonomics, and early recovery, especially in obese patients. MATERIAL AND METHODS A retrospective analysis using propensity score matching was performed on a cohort of 15 patients who received live donor robotic-assisted kidney transplants from February 2019 to April 2024, with same number of patients receiving OKT during the same period. Demographic data, ischemia and operative times, recovery, post-operative creatinine trends, and 1-month complications were recorded. Chi-square, Mann–Whitney U tests and independent t-tests were employed for data analysis based on variable type and distribution. RESULTS In a study of 30 patients (15 RAKT and 15 OKT), both groups had similar demographics and intraoperative parameters. Serum creatinine levels at 3 and 6 months showed no significant differences (p = 0.483 and 0.081). RAKT had longer rewarming times (74.60 vs 66 minutes, p = 0.01) but lower blood loss (150 vs 256.66 ml, p = 0.0004). RAKT patients ambulated (2 vs 2.46 days, p = 0.01) and passed flatus (2.8 vs 3.6 days, p = 0.03) earlier but had longer drain (7.26 vs 5.66 days, p = 0.006) and catheter removal times (9.46 vs 7.33 days, p = 0.025). OKT patients had lower tacrolimus levels (11.22 vs 6.42 µg/L, p = 0.01). Most complications were minor. CONCLUSION This propensity-matched analysis shows that both RAKT and OKT are effective and safe. However, RAKT is associated with certain advantages, including lower intraoperative blood loss, earlier postoperative mobilization, and quicker return of bowel function. Further large-scale studies are warranted to validate the generalizability of these outcomes.