Robot-assisted living-donor kidney transplantation in recipients with overweight or obesity: early outcomes from the first Swedish series
Anna Sundelin, Niclas Kvarnström, Markus Gäbel, Johan NordströmAbstract
Introduction
Kidney transplantation in recipients with overweight or obesity is associated with increased technical complexity and wound morbidity. Robot-assisted kidney transplantation (RAKT) may reduce access-related complications, but Swedish clinical data are limited. We evaluated the first Swedish single-centre series of living donor RAKT in recipients with BMI ≥28 kg/m2.
Methods
This retrospective case series included 16 consecutive recipients who underwent RAKT between 2020 and 2025. The primary endpoint was procedural feasibility. Secondary endpoints were operative time, blood loss, graft function, and postoperative complications graded according to the Clavien-Dindo classification.
Results
All procedures were completed robotically with no conversion to open surgery. Median operative time was 297 min. Estimated blood loss was low (mean 80 ml). No recipient developed delayed graft function and all grafts functioned immediately. Median serum creatinine at 1 year was 119 µmol/l among 13 recipients with follow-up. Within 30 days, 12/16 recipients experienced at least one complication; by 90 days this increased to 15/16, with no complication exceeding Clavien-Dindo grade IIIa. Major complications within 90 days (grade ≥IIIa; 7/16) represented urological interventions or diagnostic kidney biopsies. Over time (≥90 days), ureteral stricture occurred in 4 recipients, leading to surgical re-anastomosis in 3 cases.
Discussion
In this initial Swedish series, living-donor RAKT was feasible in selected recipients and yielded excellent early graft function. However, the frequency of major postoperative complications, particularly urological complications, underscores the need for continued technical refinement and prospective evaluation in larger studies.