National Comparison of Outcomes After Robotic and Open Kidney Transplantation: An Analysis of the National Inpatient Sample

Document Type

Conference Proceeding

Publication Date

1-1-2026

Publication Title

Am J Transplant

Abstract

Introduction: Currently, kidney transplant outcomes have been mainly reported on by individual transplant centers with modest sample sizes and non-standardized outcomes reporting. In this study, we aim to present national outcomes of patients after robotic versus open kidney transplantation.Methods: This was a retrospective analysis of the National Inpatient Sample, 2016-2022. Admissions for adult patients who had a kidney transplant, as well as the presence of complications during hospitalization were identified using ICD-10 codes. Patient demographics, hospital characteristics, length of stay, and disposition were gathered. Logistic regression was used to assess delayed graft function, accounting for patient demographics, comorbidities, and hospital characteristics. Multivariable log-transformed linear regression was used for length of stay.Results: A weighted estimated total of 140,495 kidney-only transplants were identified. Of these only 670 (0.47%) were estimated to be robotic. The number of robotic kidney transplants increased steadily over the assessed time period (Figure). Patients undergoing the robotic procedure were more likely to have private insurance (45.5% versus 31.1%, p=0.003), have ICD-10 codes consistent with obesity (65.7% versus 21.0%, p<0.001), and have surgery performed in large hospitals (>91% versus 83%, p<0.001). Recipients of robotic kidney transplants were less likely to experience transplant complications (15.7% vs 24.7%, p=0.02), as well as lower rates of surgical site infections or in-hospital mortality (p<0.001). Patients were less likely to have delayed graft function (<8% vs 13.1%, p=0.008) and were more likely to be transferred to another facility (p<0.001). In adjusted analyses, patients undergoing robotic kidney transplant had 64% (aOR;95% CI: 0.36;0.17-0.74) lower odds of having delayed graft function compared to open. There was no significant difference in length of stay after adjustment (exp(β) 1.01, 95%CI 0.91-1.11).Conclusions: There has historically been heterogeneity in outcomes in comparison of kidney transplant approaches across individual centers, highlighting the need for a large-scale national analysis to inform clinical decision making. This national analysis highlights that robotic kidney transplant is a viable and potentially superior alternative to its open counterpart.

Volume

26

Issue

1

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