The Early Outcomes of Robotic‐Assisted Kidney Transplantation Using Grafts With Multiple Arteries From a High‐Volume Center: A Retrospective Cohort Study

ABSTRACT Purpose Whether robot‐assisted kidney transplantation (RAKT) using grafts with multiple arteries (GMAs) is feasible has rarely been examined. This study shares our experience with RAKT using GMAs from living donors, focusing on assessing the technical feasibility and early postoperative outcomes. Materials and Methods Between July 2020 and January 2024, we prospectively collected data from consecutive patients undergoing living donor RAKT in our center. We retrospectively analyzed the clinical data of patients who underwent RAKT using grafts with a single artery (GSA) or GMAs. All vascular reconstructions of grafts with multiple arteries were performed ex vivo on the bench in iced slush, followed by robotic anastomosis of the single reconstructed artery to the external iliac artery. Results A total of 212 living donor RAKT procedures were performed by two experienced surgeons at a single institution. Using propensity score analysis, 125 recipients of grafts with a single artery (the GSA group) were selected and compared with 25 recipients of grafts with multiple renal arteries (the GMA group). There were no significant differences in the perioperative parameters or graft function outcomes between the GMA and GSA groups. Although the median operative time and revascularization ischemia times were higher in the GMA cohort, the differences were not statistically significant (200 versus 190 min, p = 0.5, and 60 versus 55 min, p = 0.8, respectively). No major intra‐ or postoperative complications were recorded in the GMA cohort. Additionally, there were no instances of graft loss or mortality during the follow‐up period in either group. Conclusions This study, the largest single‐center study of RAKT from living donors utilizing GMAs, demonstrates the technical feasibility of this approach, achieving optimal perioperative and early functional outcomes. Trial Registration : ClinicalTrials.gov identifier: NCT06577805