Robotic-Assisted Kidney Transplantation from Deceased Donors: Challenges and Opportunities

Robotic-assisted kidney transplantation (RAKT) from deceased donors presents unique challenges but offers potential to expand access and reduce surgical morbidity in selected patients, particularly those who may be contraindicated for open surgery. The technique merits careful evaluation in specialized programs, but it remains logistically complex.

Emergency timing and workforce availability limit routine implementation: donor operations are unplanned and demand immediate access to experienced robotic surgeons and perioperative teams. These constraints set a high bar—system-level readiness and trained teams are required.

Program logistics require high levels of institutional readiness, including robotic availability, rapid organ transport, and protocols to minimise cold ischemia. Centers must align scheduling, blood-bank, and ICU resources around the transplant workflow—coordinated perioperative readiness is essential for feasible RAKT.

A multicenter series of 67 patients reported median cold ischemia 14.8 hours, operative time 220 minutes, and rewarming 50 minutes; delayed graft function occurred in 27%, major complications (Clavien-Dindo ≥3) in 16%, graft survival was 92.6%, and patient survival 97.0% at a median follow-up of 27.1 months.

These outcomes support feasibility and safety in experienced centers when recipients are carefully selected and teams are highly experienced.

Key Takeaways:

• RAKT from deceased donors is feasible and safe at experienced centers and can increase transplant options for eligible ESKD patients.
• Transplant programs and patients awaiting deceased-donor organs will need adjusted resource allocation for robotics and staffing.
• Scaling deceased-donor RAKT requires 24/7 robotic availability, rapid transport workflows, and formal training pathways before expansion.