# Enhancing Kidney Transplantation Outcomes Through Robotic‐Assisted Paired Kidney Exchange: A Case Report

## TL;DR

This case report shows how robotic-assisted paired kidney exchange can improve kidney transplant outcomes by increasing compatibility and reducing recovery time.

## Contribution

The paper presents a novel application of robotic surgery in a paired kidney exchange, demonstrating improved precision and recovery.

## Key findings

- Robotic-assisted paired kidney exchange was successfully performed in two incompatible donor-recipient pairs.
- The robotic approach minimized complications and improved postoperative outcomes.
- Combining robotics with PKE can enhance compatibility and reduce invasiveness in kidney transplants.

## Abstract

Chronic kidney disease (CKD) is a significant global health challenge with a rising prevalence, primarily affecting adults with underlying diabetes and hypertension. End‐stage renal disease (ESRD), the most severe form of CKD, necessitates renal replacement therapy, such as dialysis or kidney transplantation, to sustain life. Although kidney transplantation offers superior survival and quality of life outcomes, the demand for donor kidneys far exceeds supply, leading to long waiting times and high mortality rates. Living donor kidney transplants demonstrate better outcomes, yet incompatibilities, such as blood type or human leukocyte antigen (HLA) sensitization, limit donor–recipient matches. Paired kidney exchange (PKE) is an innovative strategy that facilitates transplants between HLA‐incompatible or ABO‐incompatible donor–recipient pairs, increasing the donor pool and improving compatibility. This case report presents a PKE performed robotically at the Miami Transplant Institute, involving two incompatible pairs. Both donor and recipient surgeries were conducted using robotic‐assisted techniques, optimizing surgical precision and patient recovery. The robotic approach minimized complications, expedited recovery, and improved postoperative outcomes. This case underscores the potential of combining robotic surgery with PKE to address challenges in kidney transplantation, enhancing compatibility, and patient outcomes while reducing invasiveness and recovery time. Despite its promise, the widespread adoption of robotic‐assisted PKE is limited by cost, accessibility, and the need for robust support and educational systems to encourage donor participation.