Maximizing Robotic Efficiency in Paired Kidney Transplantation at a Resource-Limited County Hospital.

Background: Kidney transplantation is the best option for overcoming kidney replacement therapy in end-stage kidney disease. Yet the number of available deceased donors is limited. Living donor kidney transplantation offers an effective strategy to expand the donor pool, and kidney paired donation has emerged as an important alternative option. Methods: In our cases, the primary consideration was immunological incompatibility in one living donor-recipient pair and the need to appropriately match kidney volume in another pair. We retrospectively analyzed our 2-way kidney paired donation cases in which Recipient 1 received a kidney from Donor 2, and Recipient 2 received a kidney from Donor 1. In all 4 cases, the living donor nephrectomies and transplant procedures were performed using a robotic-assisted approach. Results: Both donors experienced no perioperative or postoperative complications. Both recipients demonstrated immediately graft function, with progressive normalization of serum creatinine levels through 24 months post-transplant. We successfully performed 2 robotic-assisted living donor nephrectomies and their corresponding robotic-assisted living donor kidney transplants using a single robotic platform. All procedures were conducted at our public county hospital, where resources are carefully allocated to serve the community. Conclusions: Based on the favorable outcomes observed in our robotic transplant program, the hospital plans to expand its robotic surgery program.