ROBOTIC LIVING-DONOR KIDNEY HARVESTING. DOES LONGER WARM ISCHEMIC TIME AFFECT THE TRANSPLANT OUTCOME?

Background: Warm Ischemia Time (WIT) has been proven to be detrimental for graft recovery after transplantation. We herein report the outcome of kidney transplants from living donor according to different WIT in our robotic harvesting setting. Methods: In our institution, since November 26th 2009, all kidneys harvesting from living donors have been performed using the Da Vinci robot. Different surgical techniques, different surgical teams and different instruments like, for example, the vascular stapler devices have been used. This is the reason why we experienced wide range of WIT. We finally relate the kidney transplant function to the Graft WIT in order to find out if our longest WIT has somehow affected the transplants outcome. Results: From November 26th 2009 to December 27th 2020 we performed 168 kidney transplants from living donors. WIT varied from 120 to 943 seconds (median 235). WIT has been divided in three different time intervals: A) Tertile: 1) up to 210 seconds (31.8%), 2) from 210 to 260 seconds (35.7%), 3) more than 260 seconds (32.5%); B) Median: less than 235 seconds (49%) and more than 235 seconds (51%); C) Deciles: first 9 deciles <360 seconds (89.2%), last deciles > 360 seconds (10.8%). At statistical analysis we did not find any statistically significant correlation between the WIT of our series and the kidney transplants outcome as far as creatinine at discharge, delayed graft function, acute rejections, thrombosis, urinary fistula, lymphorrea and overall complications are concerned. Conclusions: Although WIT should be kept as short as possible in organ transplantation, WIT up to 943 seconds in living donor kidney transplant doesn’t seem to have any detrimental effect on the kidney recovery after transplantation. This finding can be useful to the surgeon who will not have to rush while staplering perhaps in difficult conditions or in presence of multiple vessels.