Introduction: Obese recipients could potentially benefit from the introduction of minimally invasive techniques for kidney transplantation. We have introduced robotic kidney transplantation for our obese recipients with the hope of reducing the burden of infection and wound complication.

Material and Methods: This study is a retrospective analysis examining 203 consecutive robotic-assisted kidney transplants performed from 2009 to July 2017. Surgical outcomes, intra-operative details and post-operative courses have been described as well as clinical follow-ups in terms of kidney function and patient and graft survival.

Results: The average pre-transplant BMI was of 41.62±6.6 kg/m<sup style="font-family: Calibri, sans-serif;">2 with a maximum of 62.6 kg/m<sup style="font-family: Calibri, sans-serif;">2, the majority of the patients were African-American. Living donor transplants were performed in 69% of the cases. The mean surgical times were of 302±3.3 minutes with a warm ischemia time of 46.7±14.5 minutes. Estimated blood losses were on average 151.4cc. Five patients underwent concomitant bariatric surgeries at the time of transplant and had comparable post-operative courses. Five patients were converted to open because of atherosclerosis of the external iliac arteries. Three patients underwent early reoperation because of urinary leaks which required robotic re-implantation of the ureter to the bladder, and one due to arterial bleeding from the graft hilum. Surgical site infections occurred in only 2% of patients (4/203). Mean serum creatinine was of 1.5±0.88 mg/dL at a mean follow up of 34.17±21.23 months. 1 and 3-years patient survival was 97.4 and 95.4% and graft survival was 97.4 and 92.0%, respectively.

Conclusions: Kidney transplant can be safely performed in morbidly obese patients via minimally invasive surgery, with good surgical and clinical outcomes. The results are comparable to those of standard open kidney transplants performed in non-obese patients. In our experience, robotic kidney transplant in obese recipients has been associated with marked reduction in surgical site infection.

CITATION INFORMATION: Tzvetanov I., Di Bella C., Tulla K., Spaggiari M., Gheza F., Di Cocco P., Oberholzer J., Benedetti E. Robotic Kidney Transplantation in Obese Recipients: The New Standard? Am J Transplant. 2017;17 (suppl 3).

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