Robotic-assisted kidney transplantation 

RAKT was introduced at the Penn Transplant Institute by a team of transplant surgeons led by Samir Abu-Gazala, MD, Surgical Director of the Living Donor Kidney Team and Director of Robotic Surgery in Transplant, with Ronald Parsons, MD, the Surgical Director of the Kidney Transplant Program, and Peter Abt, MD, the Surgical Director of the Liver Transplant Program.

Robotic-assisted kidney transplantation at the PTI marks a milestone in the evolution of transplant surgery at Penn Medicine. Occurring over a period of months, this achievement involved training of the surgical team, including transplant surgeons, a surgical physician-assistant team, and operating room members, as well as careful planning and visits to other centers in the US already performing robotic kidney surgery. Multiple sessions of “dry-run practice” took place, as well, to ensure surgical team readiness for this complex procedure.

The benefits of kidney transplantation in end-stage renal disease (ESRD) include improved survival and quality of life by comparison to life on dialysis. Thus, RAKT combines the best option for the management of ESRD with one of the best approaches to kidney transplant surgery in this population.

The reported advantages of RAKT versus open kidney transplant include decreased intraoperative blood loss, reduced use of analgesic medications, and a reduced incidence of wound infections and symptomatic lymphoceles. Equivalencies between the open surgery and RAKT have been noted for hospital stay, incidence of graft rejection, graft failure, and all-cause mortality.

Urgent need for RAKT in obese populations

ESRD patients with BMIs >35 kg/m2—a parameter that describes more than 20 percent of the US population—are ineligible for transplant surgery in many transplant programs. Historically, obese patients (and particularly those with abdominal or central obesity) have been reported to have a higher incidence of surgical site infections consequent to transplant, and higher rates of graft failure and mortality.

The inauguration of RAKT for transplant recipient surgeries at the PTI has the additional benefit of expanding the populations served to include obese patients who were traditionally excluded from traditional open kidney transplant procedures due to their body habitus and increased surgical risk. The robotic approach offers these patients access to a life-saving procedure.

The potential benefits of kidney transplantation for obese patients with ESRD have been the object of several major studies, including:

• The US national registry data found that people with a BMI<40 who received a kidney transplant may have a survival advantage versus those with the same BMI remaining on the waiting list and that patients with a BMI >40 experienced a lower, but still substantial (48 percent) reduction in risk of death.
• A United Kingdom study found no difference in patient or graft survival for kidney transplantation at every BMI band from <18.5 to >40+, concluding that there was no cut-off at which kidney transplantation was not of benefit.

There is increasing evidence, in addition, that robotic-assisted surgery can mitigate some of the risks of kidney transplant surgery in general and among obese recipients in particular.

Case Report

The surgical techniques for RAKT and for RAKT in obese patients have been extensively described.

Mr. J, a 42-year-old man with a history of end-stage kidney disease secondary to focal segmental glomerulosclerosis (FSGS), was referred to the Penn Transplant Institute for a kidney transplant. After being on the waitlist for two years, a kidney became available for him as an end-chain living donor kidney.

End chain kidneys are kidneys from a living donor at the end of a paired kidney exchange chain. These living donor kidneys have now been offered to patients who have no living donors and are on the kidney transplant list at the PTI thanks to the strong collaboration between Penn and the National Kidney Registry (NKR).

For Mr. J, this was good news, but his weight was a complicating factor. At 235 lbs (BMI 34), his weight placed him near the cut-off for standard open kidney transplant surgery. He remained eligible for robotic kidney transplant surgery, however, and this option was presented to him during consultation with Dr. Abu-Gazala at the PTI, leading Mr. J to offer informed consent for the procedure.

During his RAKT, Mr. J was placed on the operating room table, and the surgical instruments were introduced to his abdomen. These instruments were docked to the robot during the procedure, enabling Dr. Abu-Gazala to control the surgery while sitting at a console at the corner of the operating room.

Robotic technology allowed the advantages of enhanced visualization and magnification, improved range of motion and dexterity, smaller incisions, and reduced trauma, all of which were of benefit to Mr. J, whose RAKT surgery was successful. In follow-up, his kidney function normalized, and he discontinued dialysis.

About Kidney Transplantation at the Penn Transplant Institute

The kidney transplant team at Penn Transplant Institute has been performing kidney transplants for almost 60 years. Penn's multidisciplinary team leads the region in the total number of transplants performed and is ranked among the top 10 multi-organ transplant centers in the country. The PTI performs more than 300 kidney transplants each year, and in 2024, almost half (48 percent) of kidney transplants involved a living donor.

In addition to kidney, liver, lung, pancreas, and heart transplantation, the PTI is involved in clinical research, physician education and training, and community outreach efforts.

Kidney transplant surgeons

• Peter L. Abt, MD
• Samir Abu-Gazala, MD - Surgical Director, Living Donor Kidney Transplant
• Kyle Jackson, MD, PhD
• Matthew H. Levine, MD, PhD
• James F. Markmann, MD, PhD - Vice-President, Transplant Services
• Ronald Parsons, MD - Surgical Director of Kidney and Pancreas Transplant
• Elizabeth Sonnenberg, MD

Kidney transplant nephrologists

• Melissa B. Bleicher, MD
• Roy D. Bloom, MD - Medical Director of Kidney and Pancreas Transplantation
• Gaia Coppock, MD*
• Kiran Goli, MD
• Simin Goral, MD
• Meera Harhay, MD
• Sabiha Hussain, MD
• Mary Ann Lim, MD
• Amanda Leonberg-Yoo, MD* - Medical Director, Living Donor Kidney Program
• Vishnu Potluri, MD
• Ghazal Quinn, MD*
• Karthik Rangana, MBA, MD
• Nay Seif, MD
• Johannes Schlondorff, MD, PhD*
• Srijan Tandukar, MD

*Living Donor nephrologists

Clinical consult and patient referral

To refer a patient to the Penn Transplant Institute, please call 800-789-7366, or submit a referral through our secure online referral form.