Robotic-assisted living donor kidney transplantation

For kidney transplant recipients, access to a living donor is the best treatment option for end-stage renal disease. Among the many benefits of living donor kidney transplantation (LDKT) for kidney recipients are reduced waiting list times, improved surgical outcomes and survival, less time on dialysis, and enhanced long-term kidney function.

However, considering the altruistic nature of living donation from healthy individuals, the safety and post-surgical well-being of living kidney donors are equally important. For these reasons, the Penn Transplant Institute introduced robot-assisted donor nephrectomies several years ago as a safe, effective, and minimally invasive surgery for the living donor community.

The advantages of robotic surgery have been well documented over time, including reduced blood loss, decreased postoperative pain, and faster recovery. Robotic surgery allows for smaller abdominal incisions and reduces the risk of hernia and infection. In addition, robotic living donor nephrectomy has proven to have equivalent perioperative outcomes and safety compared to open kidney donation in experienced centers.

Moreover, recent studies suggest that robotic surgery may allow for donation from overweight or obese individuals, a population for whom donorship had previously been linked to a higher risk of intraoperative and postoperative complications.

Case Report

Mr. K, a healthy 36-year-old man, completed a thorough medical and psychosocial evaluation and was found suitable for voluntary kidney donation. Following a consultation during which the risks and benefits of nephrectomy for donation were discussed, including potential for infection, bleeding, hernia, pain, injury to surrounding structures, and other potentially serious problems, as well as the risk of kidney failure and death, he provided informed consent for the planned procedure.

Procedure Details

Mr. K’s surgery involved the robotic retrieval of his gonadal vein, ureter, and renal artery with the donor kidney for transplantation. These procedures were accomplished without complication. Upon close inspection, the kidney was found to be of good quality with no procurement injury and was packaged in a sterile fashion for transport to the recipient’s operating room. The surgical incisions were then inspected and closed following standard procedures to ensure patient safety.

Mr. K tolerated the procedure well without apparent complications and was transferred to the post-anesthesia care unit following extubation. He remained overnight on the surgical floor and was discharged on postoperative day one.

Subsequently, he was followed closely by the living donor team, including check-in phone calls after leaving the hospital and an in-person postoperative visit two weeks after surgery. His recovery was uneventful, and he returned to work in his home office a month after surgery.

Kidney Paired Donation at Penn Medicine

The Penn Transplant Institute, which specializes in transplantation programs for the kidney, liver, lung, heart, pancreas, uterus, and hand, is now a leader in offering kidney paired donation for kidney transplants. The Living Donor Kidney Program at Penn Medicine is one of a select group of US centers designated as a Donor Care Network Center of Excellence within the National Kidney Registry (NKR), which offers enhanced support and protection for living organ donors.

The US Department of Health and Human Services has awarded the Penn Transplant Institute Kidney Transplant program a Silver Level Award. Penn is one of a few programs in the nation to receive this distinction, and the only transplant center in the region to be so recognized.

In addition to its partnership with the NKR, the Penn Transplant Institute is a member of the Organ Procurement and Transplantation Network (OPTN) Paired Donation Program (which maximizes the chance at finding a match and achieving a transplant with a living donor), and participates in the OPTN registry as well as the Alliance for Paired Donation and other registries.

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 organ transplantation, the PTI is involved in clinical research, physician education and training, and community outreach efforts.

Faculty

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.