Robotic radical prostatectomy in kidney transplant recipients: A propensity-matched cohort study.

Introduction: We aim to evaluate the perioperative, oncologic, and survival outcomes of RARP in kidney transplant recipients (KTRs) and compare to propensity-matched controls. Patients and Methods: This was a single-institution retrospective cohort study using the Northwestern Enterprise Data Warehouse. We identified eight KTRs who underwent RARP from January 2018-September 2024 and propensity matched them 1:4 with non-KTR controls using age, body mass index, and pathologic Gleason score. Outcomes were assessed using Wilcoxon rank sum and Fisher's exact tests. Overall survival was analysed using Kaplan-Meier and univariable Cox proportional hazards models. Results: All RARPs in KTRs were completed robotically. Median time from kidney transplant to RARP was 11.1 years (8.9-15.1). KTRs had higher Charlson Comorbidity Index (9.5 vs 4; p < 0.001) but similar operative time (198.5 vs 201; p = 0.8), estimated blood loss (125 vs 90 ml; p = 0.7), and length of hospital stay (1 midnight in both; p = 0.2). KTRs experienced no major complications, graft injuries, episodes of acute kidney injury, or 90-day readmissions. The 30-day urinary tract infection rate was higher in KTRs (25% vs 0%; p = 0.036), who had a median catheterization duration of 11 days (8-12.5). Surgical margin positivity (29% vs 19%, p = 0.6) and biochemical recurrence rates (13% vs 6.3%, p = 0.5) did not differ. Median follow-up time was 3.2 years in KTRs vs 1.7 years in controls (p = 0.13). Allograft function remained stable at 12 months. One KTR died from renal failure 44 months after RARP; none developed metastases or died of PCa. Conclusion: RARP in kidney transplant recipients is feasible and safe for experienced surgeons, with comparable surgical and oncologic outcomes as compared to matched controls. Higher UTI rates suggest modified catheter removal strategies could be considered.