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Minimally invasive, robot‐assisted procedure for kidney transplantation among morbidly obese: Positive outcomes at 5 years post‐transplant
Author(s) -
Spaggiari Mario,
Lendacki Frances Rose,
Di Bella Caterina,
Giulianotti Pier Cristoforo,
Benedetti Enrico,
Oberholzer Jose,
Tzvetanov Ivo
Publication year - 2018
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.13404
Subject(s) - medicine , surgery , body mass index , dialysis , complication , transplantation , diabetes mellitus , kidney transplantation , end stage renal disease , hemodialysis , endocrinology
The pre‐transplant weight loss required of end‐stage renal disease patients is often unachievable. Though robot‐assisted procedures among extremely obese have shown minimal complication, long‐term outcomes are understudied. Previously, we reported no difference in 6‐month patient and graft survival among 28 robot‐assisted transplant cases (2009‐2013) and 28 open controls (2004‐2010). Groups were frequency‐matched on age, sex, race, donor compatibility, disease, and dialysis history. Cases had greater median pre‐transplant body mass index (BMI; 42.3 (31.1‐64.3) vs 36.8 (30.0‐51.1)). Here, we compared patient and graft survival through 5 years post‐transplant. Infection, wound complications, and significant re‐hospitalizations were collected. One‐, three‐, and five‐year graft survival were 100%, 100%, and 89.3% among cases, and 96.4%, 85.7%, and 78.6% among controls. Rejection within 1 year was greater among cases (11 vs 8). Five‐year rates were similar ( P = 0.54). Post‐transplant BMI remained comparable. No cases and eight controls experienced surgical site infection (SSI). Two cases and one control experienced hernias. Post‐transplant diabetes was documented among five cases and six controls. Three deaths occurred among cases, two among controls. This is the most extensive known follow‐up of such obese recipients of robot‐assisted transplant. Our procedure is a promising pathway to transplant and decreased mortality for those deemed too high risk for conventional surgery.