Robotic Kidney Transplantation with Regional Hypothermia Versus Open Kidney Transplantation for Patients with End-Stage Renal Disease: An Ideal Stage 2B Study

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The Journal of urology


PURPOSE: To report on comparative effectiveness of minimally invasive versus traditional open kidney transplantation.

MATERIALS AND METHODS: We undertook a prospective cohort study of 654 patients who underwent open or robotic kidney transplantation at a single tertiary care hospital between January 2013 and December 2015. Primary outcome was delayed graft function (DGF), defined as the need for dialysis within 1-week of surgery. Secondary outcomes included postoperative complications, pain, graft rejection, and graft and patient survival. Non-parsimonious propensity score and Ding-VanderWeele analytical methods were utilized to adjust for confounding bias.

RESULTS: Within the 1:3 matched cohort (robotic n=126, open n=378; well-matched with standardized mean difference ∼10%), the robotic approach was associated with lower rates of wound infections (0% vs 4%, p=0.023) and symptomatic lymphoceles (0% vs 7% at 36 months, p=0.003), as well as, reduced postoperative pain, requirement for narcotic analgesia and blood loss. There were no differences among the two groups, robotic versus open, with respect to graft function (DGF 0% vs 2.4%, p=0.081), hospital stay (median 8 days for both, p=0.647), graft rejection (16.2% vs 18.6% at 36 months, p=0.643), and graft (95.2% vs 96.3% at 36 months, p=0.266) and overall survival (94.5% vs 98.1% at 36 months, p=0.307). Ding-VanderWeele analysis suggested minimal influence of unknown confounders on study findings.

CONCLUSIONS: Robotic kidney transplantation with regional hypothermia was associated with a lower rate of postoperative complications, and improved patient comfort, in comparison to open kidney transplantation. Graft function, and graft and overall survival were comparable among the two techniques.

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ePub ahead of print

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