Beyond living donation: robot-assisted kidney transplantation using deceased-donor grafts—a scoping review of selection, ischaemia logistics, and allograft outcomes

Abstract

Deceased-donor robot-assisted kidney transplantation (DD-RAKT) couples an unscheduled graft pathway with a resource-dependent operation. Living-donor-dominated reviews do not resolve DD-specific selection, ischaemia logistics, outcomes, or patient benefit. We aimed to map DD-RAKT selection, preservation-to-reperfusion logistics, outcomes, and the limits of inference about patient benefit. Following PRISMA-ScR, five sources were searched through 26 July 2026; PubMed/MEDLINE and Europe PMC were updated through 21 August 2026. Reports involving human kidney-transplant recipients and explicitly identifying DD-RAKT were eligible. We charted selection, preservation, and operative pathways, ischaemia intervals, delayed graft function (DGF), complications, and graft outcomes. Overlapping reports were clustered; counts and event rates were not pooled. The combined searches returned 2,789 source records; 1,324 unique records remained after deduplication; 64 reports were assessed; and 33 were included. The reports mapped to 19 programme clusters; 18 were deceased-donor-only reports and 15 were mixed-donor reports. The largest single-centre series included 125 deceased-donor recipients: DGF occurred in 38 (30.4%), death-censored graft loss in two (1.6%), and death within 1 year in three (2.4%); median follow-up was 9.9 months. Cold ischaemia showed a graded observational association with DGF in a separate 115-recipient cohort. Selection denominators and linked preservation-to-outcome timelines remained uncommon. Published evidence supports technical feasibility in selected recipients at experienced centres. It does not establish superiority, net patient benefit, or universal thresholds for cold ischaemia, anastomotic time, graft temperature, or pneumoperitoneum pressure. The proposed dataset provides a descriptive audit framework; causal questions about cooling and pressure require prospective controlled studies.