Oncological and Postoperative Outcomes of Robot-Assisted Laparoscopic Radical Prostatectomy in Renal Transplant Recipients: A Multicenter and Comparative Study.

Background: Robot-assisted laparoscopic radical prostatectomy (RARP) has been poorly studied in men with renal graft.
Objective: To determine the predictive factors for oncologic outcomes and complications after RARP in renal transplants recipients (RTRs).
Design and Participants: A retrospective multicenter controlled study identified all RTRs who had undergone RARP between 2008 and 2016 in 2 experts departments. All RTRs were matched 1:1 with patients who had also undergone RARP but with no history of renal transplant (control group).
Intervention: Robot-assisted laparoscopic radical prostatectomy.
Outcome Measurements: Incontinence, oncologic outcomes, and complications according to the Clavien-Dindo classification.
Statistical Analysis: Comparisons of the quantitative variables using Student's t tests, and comparisons of the qualitative variables using χ2 tests. Statistical analyses were performed using SAS (version 9.3). Independent risk factors of biochemical recurrence (BCR), postoperative complications, or incontinence were searched by using a multivariate linear regression.
Results: Twenty-seven RTRs were included in the transplant group and compared with 27 men in the control group with similar preoperative characteristics. Univariate analysis showed a shorter BCR-free survival in RTRs, with 26.9 months vs 49.3 months in the control group (P = .018). BCR rate was similar in each group (7.4% vs 11.1%, P = .639). No difference between groups was showed for immediate postoperative complications (29.6% vs 22.2%, P = .279). Multivariate analysis showed that a renal graft history was an independent risk factor of shorter BCR-free survival (hazard ratio = 4.291; 95% confidence interval, 2.102-8.761 and P < .001). Even if it is the first comparative study on this topic, the low number of men included is the main limitation of our study.
Conclusions: These findings show the reliability of RARP in RTRs. The rate of BCR does not appear more frequently but BCR-free survival seems shorter in these patients. A prospective comparative study remains necessary with more patients to confirm our results.
(Copyright © 2020 Elsevier Inc. All rights reserved.)