Study: Robotic transplants safe for obese patients with kidney disease
Wednesday, December 11, 2019
University of Illinois at Chicago research finds that robotic kidney transplants for obese patients result in survival outcomes comparable to those in nonobese patients.
Published in the American Journal of Transplantation, the study highlights 10 years' worth of data from some 230 robotic-assisted kidney transplants in patients with obesity conducted at University of Illinois Health hospitals.
The study reports one- and three-year patient survival rates of 98% and 95%, respectively, among kidney transplant patients with obesity. Only 17 of 239 patients developed graft failures and returned to dialysis, resulting in a 93% three-year kidney graft survival rate.
Patients had a median age of 48 and a median body mass index of 41.
Wound complications occurred in nine patients and a surgical site infection occurred in only one patient. The study reports that 88 patients were readmitted to the hospital within 30 days, but only 10 readmissions were related to surgical complications.
When compared to nonobese patients, the results are strikingly similar. Nonobese patient results were gleaned from the United Network for Organ Sharing for the same time period, January 2009 to December 2018.
Patients who are obese aren't good candidates for surgery, so they have traditionally been deemed ineligible for kidney transplants, says Dr. Mario Spaggiari, assistant professor of surgery at the University of Illinois at Chicago's College of Medicine.
"Advances in surgical care, including increasing proficiency and acceptance of robotic surgery, are making kidney transplants a safe option for more people," Spaggiari said.
Robotic surgery helps to lessen adverse surgical events associated with obesity in open transplants, Spaggiari said. Specifically, the number of post-surgical wound infections dramatically reduces when robotic surgery is used to perform the transplant. This is an important factor in the long-term viability of the transplanted organ.
Surgeons at University of Illinois Health were among the first to offer robotic kidney transplants to obese patients. Transplants using the technology have been performed at UI Health since 2009.
"Our surgical program is focused on advancing care for everyone, including members of vulnerable communities who experience increased rates of various comorbidities, including obesity," said Dr. Enrico Benedetti, professor and Warren H. Cole Chair of Surgery.
"Ten years of transplant experience shows us that obesity does not have to be a disqualifying factor in kidney transplants. To our knowledge, this is the largest cohort to date of robotic kidney transplants and these findings tell us that kidney transplantation is a viable option for many people with obesity," Benedetti said.
"The patients who received transplants spent more than three-and-a-half years on dialysis before undergoing surgery, and that is just the median number," Spaggiari said. "Without surgery, these people would have had no choice but to remain on dialysis — which can itself be a barrier to achieving an 'ideal' weight for transplant — and accept the limitations it places on their quality of life. With surgery, they can get back to normal life, which is most important. They can also have increased chances of achieving other health-promoting behaviors, like exercise or weight loss."
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