Robotic-assisted kidney transplantation in obese recipients compared to non-obese recipients : the European experience

Purpose The main objective was to compare minor (Clavien I-II) and major (Clavien >= III) intra- and postoperative complications of living donor robotic assisted kidney transplantation (RAKT) in obese (>= 30 kg/m(2)BMI), overweight (< 30/ >= 25 kg/m(2)BMI) and non-overweight recipients (< 25 kg/m(2)BMI). Methods For the present retrospective study, we reviewed the multi-institutional ERUS-RAKT database to select consecutive living donor RAKT recipients. Functional outcomes, intra- and postoperative complications were compared between obese, overweight and non-overweight recipients. Results 169 living donor RAKTs were performed, by 10 surgeons, from July 2015 to September 2018 in the 8 European centers. 32 (18.9%) recipients were obese, 66 (39.1%) were overweight and 71 (42.0%) were non-overweight. Mean follow-up was 1.2 years. There were no major intra-operative complications in either study group. Conversion to open surgery occurred in 1 obese recipient, in 2 overweight recipients and no conversion occurred in non-overweight recipients (p = 0.3). Minor and major postoperative complications rates were similar in the 3 groups. At one-year of follow-up, median eGFR was similar in all groups [54 (45-60) versus 57 (46-70) versus 63 (49-78) ml/min/1.73 m(2)in obese, overweight and non-overweight recipient groups, respectively,p = 0.5]. Delayed graft function rate was similar in the 3 groups. Only the number of arteries was an independent predictive factor of suboptimal renal function at post-operative day 30 in the multivariate analysis. Conclusion RAKT in obese recipients is safe, compared to non-overweight recipients and yields very good function, when it performed at high-volume referral centers by highly trained transplant teams.