*Purpose: Following rapid advancements in minimally invasive urology, living donor robotic-assisted kidney transplantation (RAKT) has developed into a feasible alternative to open kidney transplantation (OKT). The procedure has been performed in multiple international programs, but a relative death of experience exists in the US. In this study, we compare RAKT to OKT using a propensity score analysis to elucidate the efficacy of RAKT as an alternative to OKT.

*Methods: A retrospective review of 101 living kidney transplants (36 RAKT, 65 OKT), which occurred between Jan 2016 and June 2018, was conducted. Selection for RAKT was based on robot availability. Recipient and donor demographics variables were collected, in addition to perioperative parameters. A propensity score analysis was performed, matching for recipient age, gender, body mass index (BMI), race, preoperative dialysis, preoperative serum creatinine (SCr), cPRA, and donor age. Primary outcomes assessed postoperative SCr at five time points (days three, seven, fourteen, six months, and one year). Final analysis included 35 patients in each group.

*Results: Recipients’ (N=101) mean age was 49 years (range 19-74), with RAKT recipients slightly younger than OKT recipients (46 vs 51 years). 61 recipients (59%) were male and 62 recipients (61%) were white (29 Black, 10 other). Average recipient BMI was 29 (range 20-40), with equivalent BMIs in RAKT and OKT subsets. Following propensity score analysis, RAKT recipients demonstrated significantly greater warm ischemic times (49 vs 38 minutes, p<0.001) and less blood loss (62.5 vs 150 ml, p<0.001), but operative time and length of stay were not significantly different in the groups. Of note, post-operative SCr measured at each of five time-points, was not significantly different between groups.

*Conclusions: Notably, this study compares RAKT to OKT with a heterogenous study population, using propensity scoring; the first of its kind in the US. Despite the significantly longer WIT in RAKT, we found equivalence of SCr in the early and intermediate postoperative period. Although the small sample size limits the ability to detect certain differences in graft and patient outcomes, trends demonstrate shorter length of stay, shorter operative time, and less blood loss for RAKT recipients. Additionally, trends demonstrate less narcotic use by the second postoperative day. Early findings in RAKT demonstrate a reasonable alternative for kidney transplantation in various populations, with similar graft and patient outcomes.

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