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Renal transplantation

Presented by
Dr Mireia Musquera, Dr Mark Sullivan
EAU 2019
ERUS-RAKT project data supports the use of robotic laparoscopy for living donor transplantations in expert centres and renal transplantation can be considered in complex renal tumours with an imperative indication for organ sparing.

An award-winning poster from Dr Mireia Musquera Felip et al. (Hospital Clinic Barcelona, Spain) reported their experience with robot-assisted kidney transplantation (RAKT) after 3 years, involving 185 RAKTs from 8 European centres (ERUS-RAKT project), most of which were living donor transplantations. The operating times, ischaemia times, and anastomosis times were all reasonable (see Table). Although some vascular complications were reported in the beginning of the project, the learning curve accelerated and fewer complications were reported later. The authors claim that they provide good surgical and functional results, which are competitive to the open technique. However, it is unclear what the exact benefits to the patient are to justify this approach; for example, ideally less hernia or wound infection would be associated with the same functional outcome.

Table: Surgical characteristics of 185 robot-assisted kidney transplantations in ERUS-RAKT project

ERUS-RAKT, EAU Robotic Urology Section – Robot-Assisted Kidney Transplantation.

In another study, Dr Mark Sullivan et al. (Oxford University, United Kingdom) presented a study about renal transplantation for larger kidney tumours (6.2 cm on average). Of the 36 patients included (most presented with solitary kidneys), 34 of the tumours were highly complex. The positive surgical margin rate was 5.6%, Clavien-Dindo III-V complications were reported in 56%, and there was relatively high mortality at 5.6%. With a 60-month follow-up, there was an impressive cancer-free survival of 96%. Furthermore, 79% were recurrence-free, and 83% were dialysis-free. The authors concluded that in selected patients, this approach offers a chance for renal preservation without compromising cancer control; the surgery itself is however complex and potentially hazardous.

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