Expanding the living kidney donor pool: outcomes of robotic donor nephrectomy in obese versus non-obese donors.

Authors

Jacob Hallesy, Derick Nguyen, Devi Preetham Reddy Veeramgari, Daisuke Imai, Yuzuru Sambommatsu, Vinay Kumaran, Muhammad Saeed, Aamir Khan, Amit Sharma, Adrian Cotterell, David Bruno, Seung Duk Lee

Published in

Surgical endoscopy. Sep 08, 2026. Epub Sep 08, 2026.

Abstract

Robotic donor nephrectomy (RDN) offers a minimally invasive alternative to open and laparoscopic techniques for living kidney donation. As obesity rises among potential donors, data comparing RDN outcomes between non-obese and obese donors remain limited. This study evaluates the safety and feasibility of RDN in obese living kidney donors.
A single-center retrospective analysis included 212 consecutive donors who underwent RDN between August 2020 and April 2025; after excluding one donor with incomplete covariate data, 211 (137 low BMI [< 30 kg/m²], 74 high BMI [≥ 30 kg/m²]) formed the analytic cohort. To account for baseline imbalance, the primary between-group comparison used propensity-score overlap weighting, with weighted differences and 95% confidence intervals (CIs) estimated by robust weighted regression.
Low BMI donors were modestly older (46.2 vs. 42.2 years; largest imbalance, standardized mean difference 0.32); overlap weighting reduced all covariate differences to approximately zero. After weighting, operating time was longer in high BMI donors (weighted difference + 15.6 min, 95% CI 6.4-24.8; p < 0.001), whereas estimated blood loss, conversion to open surgery (1.4% vs. 0.7%), complications (2.7% vs. 2.2%; all Clavien-Dindo Grade I), length of stay, and renal function through six months did not differ (all weighted p > 0.10). No perioperative deaths occurred. Exploratory subgroup analyses showed longer operating times for high BMI donors with single renal arteries (p = 0.011) and left nephrectomies (p = 0.024), without differences in blood loss or complications.
In a rigorously selected cohort, RDN yielded short-term perioperative and functional outcomes in obese donors comparable to non-obese donors, with only a modest increase in operative time that persisted after overlap weighting. These findings support RDN as one component of responsibly expanding the donor pool; however, short-term parity does not establish long-term donor or recipient safety, and expansion must remain contingent on stringent selection, risk counseling, and structured long-term surveillance.

PMID:
42711589
Bibliographic data and abstract were imported from PubMed on 09 Sep 2026.

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