Minimally Invasive Robotic Kidney Transplantation for Obese Patients Previously Denied Access to Transplantation

摘要

The authors report results on a new robotic kidney transplantation technique for obese patients that has comparable patient outcomes compared to an open procedure. The authors report results on a new robotic kidney transplantation technique for obese patients that has comparable patient outcomes compared to an open procedure. Obese patients with end-stage renal disease (ESRD) are often excluded from kidney transplantation due to concerns about surgical site infections. To reduce infections, we developed a robotic kidney transplantation method for obese recipients. From June 2009 to December 2011, a prospective cohort of 39 obese patients underwent robotic kidney transplantation at a single center. The outcomes of patients with at least 6 months of follow-up (n = 28) were compared to a frequency-matched retrospective cohort of obese patients who underwent open kidney transplantation from 2004 to 2009 (n = 28). The 28 robotic patients were predominately African American (46.4%) or Hispanic (35.7%), with a mean age of 47.9 ± 10.7 years, similar to the control group. BMI in the robotic group was 42.6 ± 7.8 kg/m2 compared to 38.1 ± 5.4 kg/m2 in the control group (p = 0.02). There were no surgical site infections in the robotic group (0/28), while 28.6% (8/28) in the control group developed an infection (p = 0.004). Six-month creatinine (1.5 ± 0.4 vs. 1.6 ± 0.6 mg/dL; p = 0.47), and patient and graft survival (100%) were comparable between the two groups. Outcomes following robotic surgery compared favorably to conventional transplantation. Robotic surgery may therefore enable obese patients with ESRD to access kidney transplantation and may thereby reduce health disparities in groups with a high prevalence of obesity and ESRD. Epidemiological data indicate that 20–50% of patients on dialysis for end-stage renal disease (ESRD) are obese (body mass index [BMI] ≥30 kg/m2) (1U.S. Renal Data System. USRDS 2011Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States.. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD2011Google Scholar). Obese patients with chronic renal failure have longer wait times until kidney transplantation (2Segev DL Simpkins CE Thompson RE Locke JE Warren DS Montgomery RA Obesity impacts access to kidney transplantation.J Am Soc Nephrol. 2008; 19: 349-355Crossref PubMed Scopus (183) Google Scholar) and inferior patient outcomes (3Modlin CS Flechner SM Goormastic M et al.Should obese patients lose weight before receiving a kidney transplant?.Transplantation. 1997; 64: 599-604Crossref PubMed Scopus (144) Google Scholar, 4Meier-Kriesche HU Vaghela M Thambuganipalle R Friedman G Jacobs M Kaplan B The effect of body mass index on long-term renal allograft survival.Transplantation. 1999; 68: 1294-1297Crossref PubMed Scopus (136) Google Scholar, 5Pischon T Sharma AM Obesity as a risk factor in renal transplant patients.Nephrol Dial Transplant. 2001; 16: 14-17Crossref PubMed Scopus (76) Google Scholar, 6Meier-Kriesche HU Arndorfer JA Kaplan B The impact of body mass index on renal transplant outcomes: A significant independent risk factor for graft failure and patient death.Transplantation. 2002; 73: 70-74Crossref PubMed Scopus (476) Google Scholar, 7Meier-Kriesche HU Kaplan B Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: A paired donor kidney analysis.Transplantation. 2002; 74: 1377-1381Crossref PubMed Scopus (627) Google Scholar). In the United States, for example, patients with a BMI < 25 kg/m2 have a median wait time of 39 months for a deceased donor kidney transplantation compared to 59 months in patients with a BMI > 40 kg/m2 (2Segev DL Simpkins CE Thompson RE Locke JE Warren DS Montgomery RA Obesity impacts access to kidney transplantation.J Am Soc Nephrol. 2008; 19: 349-355Crossref PubMed Scopus (183) Google Scholar). Higher BMIs in kidney transplant recipients a