Robot-assisted versus conventional open kidney transplantation: a propensity matched comparison with median follow-up of 5 years.

IF 1.5 Q3 UROLOGY & NEPHROLOGY American journal of clinical and experimental urology Pub Date : 2023-01-01
Abhijit Patil, Arvind Ganpule, Abhishek Singh, Anshul Agrawal, Pratik Patel, Nitiraj Shete, Ravindra Sabnis, Mahesh Desai
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Abstract

Background: RAKT is a relatively newer approach for kidney transplant and has to be proven against the established approach, OKT. RAKT may be beneficial in obese patients as described in literature. Hence, we compared pre-, intra- and postoperative parameters with one year follow-up of both approaches by propensity matching similar characteristics patients.

Methods: Data of 28 OKT and 28 RAKT propensity matched patients was collected during 2014 to 2022 through the institutional transplant registry. OKT and RAKT patients were propensity matched for confounding factors like donor age, eGFR, side along with recipient age, BMI and comorbidities. All graft kidneys were harvested laparoscopically.

Results: Both the groups were comparable in terms of recipient age and BMI, donor age, creatinine, BMI, eGFR and comorbidities. Total ischemia time (P<0.001) and postoperative day (POD) 1 creatinine (P<0.001) was significantly more in RAKT. However, postoperative 1 month (P=0.12), 3 months (P=0.60) and 1 year (P=0.10) creatinine was comparable in both approaches. Postoperative complications (P=0.90) including hemoglobin drop (P=0.72) were comparable in both the groups. The days to half the creatinine from preoperative values was significantly less in OKT group (P=0.009). Serum Tacrolimus levels at day 3 (P=0.08) and day 7 (P=0.112) were also comparable in both the groups. Graft survival was 78.5% in OKT group and 82.14% in RAKT group with median follow-up of 60 months in both the groups.

Conclusion: In this comprehensive propensity matched analysis of RAKT with OKT, we conclude that RAKT has similar outcomes as OKT at 1 year and 5 years follow-up. CIT, TIT, time to half creatinine and POD 1 creatinine values were higher in RAKT group, but eventually have comparable outcomes at further follow-up. Thus, RAKT, a novel approach is non-inferior to established OKT approach. However, further larger trials are required.

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机器人辅助与传统开放肾移植:中位随访5年的倾向匹配比较。
背景:RAKT是一种相对较新的肾脏移植方法,并且必须与既定的方法OKT相比较。如文献所述,RAKT可能对肥胖患者有益。因此,我们通过倾向匹配相似特征的患者,比较了两种方法的术前、术中和术后一年随访参数。方法:通过机构移植登记处收集2014年至2022年28例OKT和28例RAKT倾向匹配患者的数据。OKT和RAKT患者在供体年龄、eGFR、受体年龄、BMI和合并症等混杂因素上倾向匹配。所有移植肾均在腹腔镜下摘取。结果:两组在受体年龄和BMI、供体年龄、肌酐、BMI、eGFR和合并症方面具有可比性。结论:在RAKT和OKT的综合倾向匹配分析中,我们得出结论,RAKT在1年和5年随访时的结果与OKT相似。在RAKT组中,CIT、TIT、到一半时间肌酐和POD 1肌酐值较高,但在进一步随访中最终具有相当的结果。因此,RAKT,一种新颖的方法是不逊色于既定的OKT方法。然而,还需要更大规模的试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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