BackgroundKidney transplant rejection is a major cause of graft dysfunction and failure. In recent years, there has been increased interest in renal allograft protocol biopsies to allow earlier detection of acute or chronic graft dysfunction or rejection to improve long-term graft survival and reduce graft failure. This study aimed to determine if renal allograft protocol biopsies performed within the first 12 months after transplantation help detect subclinical graft dysfunction or rejection. MethodsWe performed a retrospective analysis utilizing SUNY Upstate University Hospital data from January 2016 to March 2022 to assess transplant outcomes and biopsies. The study population was divided into two subgroups: non-protocol biopsies and protocol biopsies within the 12 months post-transplant. ResultsA total of 332 patients met our inclusion criteria and were included in the study. Patients were divided into two subgroups: 135 patients (40.6%) in the protocol biopsy group and 197 patients (59.4%) with nonprotocol indication biopsies during the first year after the transplant. The overall number of rejection episodes reported was eight episodes (4.6%) in the protocol biopsy group and 56 episodes (18.3%) in the non-protocol indication biopsy group, which was significantly higher in the non-protocol biopsy group (P=0.001). Antibody-mediated rejection (ABMR) and T-cell-mediated rejection (TCMR) diagnoses were significantly higher in the non-protocol biopsy group (P=0.03 and P=0.03, respectively). We also mentioned a trend in terms of mixed antibody-mediated rejection and T-cell-mediated rejection diagnosis (P=0.07). One year after the rejection, the mean glomerular filtration rate (GFR) was 56.78 mL/min/1.73m 2 in the protocol biopsy group and 49.14 mL/min/1.73m 2 in the non-protocol indication biopsy group, and there was no significant difference anymore (P=0.11). The patient survival rate was not significantly higher in the protocol biopsy group compared to the non-protocol indication biopsy group (P=0.42). ConclusionThis study suggests that performing protocol biopsies does not significantly benefit rejection rates, graft survival, or renal function within the first 12 months post-transplant. Given these results and the small but non-zero risk of complications associated with protocol biopsies, they should be reserved for those patients at high risk of rejection. It may be more feasible and beneficial to utilize less invasive tests, such as DSA and dd-cfDNA testing, for early diagnosis of a rejection episode.

BackgroundWe aimed to explore differences in outcomes of robotic and laparoscopic donor nephrectomies (LDN).MethodsThis study compared robotic and laparoscopic surgical techniques for live donor nephrectomies in 153 patients at a single centre.ResultsLeft nephrectomies were more common in both groups, but with no significant difference between the groups (76.6% vs. 77.6%, p = 0.88). The robotic donor nephrectomies (RDN) group experienced significantly less blood loss (60 vs. 134 mL, p < 0.01), but warm ischaemia time was similar between groups (3.2 vs. 3.7 min, p = 0.54).The RDN group had decreased subjective pain scores (3.54 vs. 4.21, p = 0.04) and shorter length of hospitalisation (2.22 vs. 3.04 days, p < 0.01).There were also fewer complications in the RDN than the LDN group (4 vs. 8, p = 0.186).ConclusionThis study demonstrated that RDN is a safe and alternative to LDN. Decreased blood loss and hospital stays and fewer complications may reflect decreased tissue manipulation with robotic assistance.

Background Currently, over 63,000 pancreas transplant procedures have been performed worldwide, with only approximately 8% of all pancreas transplants having been a pancreas transplant alone. Our study aimed to quantify outcomes following pancreas transplant alone in the United States from 2001 to 2020, with an emphasis on graft and patient survival. Methods and materials We performed a retrospective registry analysis utilizing the OPTN/UNOS database for pancreas transplants alone performed in the United States from January 2001 to May 2020 to assess transplant outcomes. The study population was divided into two subgroups: patients receiving a pancreas transplant between 2000 and 2009 and those receiving a pancreas transplant between 2010 and 2020. Results 3008 allograft recipients were included in the study. 1679 (54.87%) transplants were done from January 2000 to the end of 2009. 1381 (45.13%) transplants were done from 2010 to May 2020. Although the BMI and recipient sex comparison indicate a statistically significant difference, the differences are not clinically significant. The overall 5‐year allograft survival rate was 52.17% in the 2000–2009 group, which increased to 58.82% in pancreas transplants alone from 2010 to 2020 (P = 0.02). The overall 5‐year patient survival rate was 74.52% in the 2000–2009 group, which increased to 74.92% in pancreas transplants alone from 2010 to 2020 (P = 0.81). Conclusion With all the progress in terms of surgical techniques, organ allocation and preservation, and immunosuppressive regimens, the pancreas transplant alone allograft survival has been improving over the years, although it has been still being underutilized around the US.

Background: We aimed to investigate how surgeon experience in different time points impact donors’ outcome. Methods: This is a retrospective study comparing outcome of 77 living kidney donors who had robotic living donor nephrectomies (RDN) performed at a single institution. Donors separated into three groups: 25 patients constituting the learning curve period (LCP), 25 patients constituting the stabilization period (SP), and the 27 patients constituting the teaching period (TP). The groups were compared by collecting data on pre-, intra- and postoperative parameters and costs. Results: Among the three RDN groups, there were significant differences in blood loss (102 mL vs 39 mL vs 41 mL, p=0.01), intra-operative fluids administration (3.2 L vs 3.1 L vs 2.7 L, p=0.45), hospitalization times (2.96 days vs 1.92 days vs 1.85 days, p<0.01), and morphine milligram equivalents (MME) (2068 vs 375 vs 222, p<0.01). Operative time was significantly shorter in the LCP group compared to the TP group (282 min vs 308 min vs 314, p=0.02). However, warm ischemia time was shorter in the TP group compared to the LCP group (5.0 min vs 3.4 min vs 1.5 min, p<0.01). Complication rates were significantly higher in the LCP group compared to the SP and TP groups (p=0.04), but readmission within 30 days was similar at all surgical time points(p=0.58). Surgical costs ($73,756 vs $82,949 vs $91783, p<0.01) were higher in both the SP and TP groups. Conclusion: This study has demonstrated that RDN outcomes improve significantly after the initial learning curve of the technique.