Robotic Kidney Transplant Beyond the Learning Curve: 8-Year Single-center Experience and Matched Comparison With Open Kidney Transplant.

OBJECTIVE: To investigate the medium to long-term outcomes of robotic-assisted kidney transplantation (RAKT) and propensity-matched comparison with open kidney transplant (OKT). MATERIALS AND METHODS: We retrospectively reviewed 342 patients from database, who underwent RAKT and OKT from January 2015 to May 2022, at our center. Various demographic, intraoperative, and postoperative parameters were evaluated. Statistical analysis including propensity matching using nearest neighbor algorithm was performed to ensure comparability between the RAKT and OKT groups. The statistical analyses were performed using SPSS v.22.0 (IBM Corp, Armonk, NY) and STATA 13 (Stata Corp, College Station, TX). All statistical tests were two-sided, and a significance level of P < .05 was considered statistically significant. RESULTS: After applying exclusion criteria, 196 RAKT patients and 102 OKT patients were included in the analysis. Propensity score matching resulted in the inclusion of 173 patients in the RAKT group. In the propensity-matched comparison of intra/perioperative parameters, RAKT showed significant reductions in total surgical time (P < .001), wound length (P < .001), blood loss (P < .001), blood transfusion rate (P < .001), pain score (P < .001), and analgesia requirement (P < .001). Graft survival and patient survival rates were comparable in RAKT and OKT groups at the end of 60months. CONCLUSION: RAKT offers several advantages over OKT in terms of reduced operative time, blood loss, pain, and analgesia requirements. RAKT shows comparable graft and patient survival rates to OKT in the medium to long term.

Anesthetic Challenges and Perioperative Factors Affecting Delayed Graft Function in Robotic-Assisted Kidney Transplant: A Review of a Single-Center Experience of 100 Cases.

Background and objective The advent of robot-assisted kidney transplant (RAKT) has ushered in a new set of challenges. In this single-center retrospective observational study, we aimed to highlight the anesthetic challenges and analyze perioperative parameters to identify the risk factors for delayed graft function (DGF) in RAKT. Methods A descriptive analysis of perioperative factors of the first 100 cases of RAKT at our center was performed. Data were retrieved from the hospital's electronic medical records (EMR) of donors and adult patients who underwent RAKT between July 2015 and December 2020. The data analyzed included demographics, preoperative optimization, intraoperative and postoperative management, and complications. DGF was defined as a requirement of dialysis within one week of transplant. The Fisher's exact test, independent sample t-test, and the Mann-Whitney test were used to analyze data. Results Among a total of 193 renal transplants performed during the study period, 100 patients underwent RAKT, which included 27 females and 73 males. Of these, 91 were live while the remaining involved deceased-donor transplants. Pneumoperitoneum and steep Trendelenburg position required various "anesthetic maneuvers" to maintain hemodynamics and respiratory parameters. Optimal fluid management, with frusemide and mannitol, ensured good urine output (UOP) (93%). Post-reperfusion, the release of pneumoperitoneum, maintenance of adequate perfusion pressures, immunosuppression, and regional hypothermia helped in ensuring adequate graft function (93%). The incidence of DGF in our series was 7% and the mortality rate was 3%. Recipient age (p=0.045), dyslipidemia (p=0.021), and diabetes mellitus (p=0.023) were identified as significant risk factors for DGF. Conclusion Advanced recipient age, diabetes, and dyslipidemia were factors significantly associated with DGF in RAKT in our series of 100 cases. However, the duration of the steep Trendelenburg position, docking of robot/pneumoperitoneum (console time), fluid management, warm and cold ischemia times, rewarming time, and type of graft did not influence DGF. Awareness of the systemic involvement in RAKT, proper preoperative optimization, and knowledge of potential problems are essential for the efficient anesthetic management of RAKT.

Malignant hyperthermia during pediatric kidney transplantation-A medical and ethical quandary.

Malignant hyperthermia (MH) is a rare life-threatening anesthetic complication with high mortality rates. MH during adult kidney transplant has been reported previously. However, the occurrence of MH after multiple previous uneventful anesthetic exposures in a pediatric kidney transplant recipient is rare. To our knowledge, this is the first reported case of MH in a child undergoing a live donor kidney transplant. The approaches for addressing perioperative challenges and ethical dilemmas to ensure successful outcomes are described. The recipient, a 5-year-old male child, weighing 20 kg, with a history of multiple previous uneventful anesthetic exposures, underwent live donor kidney transplant for end-stage renal disease (ESRD). Post-reperfusion he developed fulminant MH with rapidly progressing hyperthermia, hypercarbia, tachycardia, and muscle rigidity, which in addition to complicating the medical management raised several ethical issues as well. MH was successfully managed with dantrolene and other supportive measures. Judicious use of inotropes and fluids helped maintain stable hemodynamics and graft perfusion. Management of MH is complicated in a pediatric patient with ESRD undergoing live donor kidney transplant. Preference for non-depolarizing muscle relaxants instead of succinylcholine during endotracheal intubation can result in delayed onset of clinical manifestations. However, the metabolic complications may be more severe due to preexisting electrolyte and acid-base disturbances. Maintaining optimal graft perfusion while simultaneously combating MH can be very challenging in a child. Since the allograft is a precious commodity, critical decisions regarding the harvesting of the donor kidney need to be well thought out. Early diagnosis and prompt treatment with dantrolene are critical to preserving graft function and the recipient's life.

Combined liver-kidney transplant in a 21-month-old child with type 1 primary hyperoxaluria-The perioperative challenges.

Primary hyperoxaluria type 1(PH 1) is the most common indication for a paediatric combined liver-kidney transplant. It is a technically challenging procedure. We describe the challenges in managing a 21-month-old female child weighing 7 kg for a combined liver-kidney transplant from two related living donors.