Robotic Kidney Transplantation with Regional Hypothermia Versus Open Kidney Transplantation for Patients with End-Stage Renal Disease: An Ideal Stage 2B Study
Ahlawat R, Sood A, Jeong W, Ghosh P, Keeley J, Abdollah F, Kher V, Olson P, Farah G, Wurst H, Bhandari M, and Menon M. Robotic Kidney Transplantation with Regional Hypothermia Versus Open Kidney Transplantation for Patients with End-Stage Renal Disease: An Ideal Stage 2B Study. J Urol 2020.
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.
ePub ahead of print