*Purpose: Obesity significantly impacts intraoperative and postoperative complications following kidney transplantation. Consequently, many centers deny access to transplantation in patients with a body mass index (BMI) above 35. The present study aimed to compare the short-term outcome between conventional open kidney transplant (OKT) and robot-assisted kidney transplantation (RAKT) in morbidly obese patients (BMI of 35 or greater with end-stage renal disease).

*Methods: From August 2017 to December 2019, consecutive cases of RAKT among morbidly obese patients were enrolled at a single center initiating a robotic transplant surgery program. Outcomes of patients who underwent RAKT were compared to those of frequency-matched, morbidly obese patients who underwent OKT during the same period.

*Results: A total of 24 patients successfully underwent RAKT, and they were frequency matched with 16 (of 49) obese patients who underwent OKT. The OKT and RAKT groups had a median BMI of 38.54 (range, 35-43) and 40.10 (range, 35-49), respectively (p = 0.055). We were able to match patient characteristics between both groups. Operative time was similar between both groups (OKT vs RAKT; 336.38 vs. 347.25 min, respectively; p = 0.671). No significant differences in postoperative outcomes, including rejection, deep vein thrombosis, urinary tract infection, and reoperation, were observed between both groups. However, the OKT group developed more surgical site infections (SSIs) than the RAKT group (one superficial SSI for RAKT vs. one deep and four organ-specific SSIs for OKT; p = 0.007). Graft function, including creatinine and glomerular filtration rate, were similar between both groups 1 year after surgery.

*Conclusions: RAKT offers a safe alternative for morbidly obese patients, who may otherwise be denied access to OKT.

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