Pavel NAVRATIL, Hanka PRINCLOVA, Oleg IZMAYLOV, Minh Nguyet TRANOVA
Experimental and Clinical Transplantation - 2026;24(9):664-675
Objectives: We systematically reviewed evidence on robot-assisted radical prostatectomy in kidney transplant recipients with prostate cancer, focusing on perioperative safety, allograft preservation, oncological and functional outcomes, pelvic lymph node dissection, technical modifications, and future reporting standards. Materials and Methods: For the structured literature update, we used PubMed/MEDLINE-indexed records, Europe PMC/PMC material, publisher pages, DOI searches, and backward/forward citation tracking through May 4, 2026. For the anchor evidence base, we used a published literature review that studied data through April 2023. We screened studies post-April 2023 for robot-assisted radical prostatectomy-specific data and for broader radical prostatectomy data relevant to selection, graft outcomes, competing mortality, and surgical strategy. Because cohorts were small, endpoints heterogeneous, and multicenter series potentially overlapping, we synthesized findings narratively rather than pooled findings quantitatively. Results: The pre-2023 evidence on robot-assisted radical prostatectomy comprised 18 retrospective studies (186 patients). Operative time ranged from ~108 to 400 minutes, estimated blood loss from 30 to 630 mL, length of stay from 3 to 6 days, and catheterization from 5 to 18 days. The aggregate complication rate was 17.1%, with grade 3 or higher events in 8 patients. Positive surgical margins occurred in 24.2% and biochemical recurrence in 10.2%, although follow-up and risk distributions were heterogeneous. The largest multicenter robot-assisted radical prostatectomy series reported no graft injury, stable renal function, 1 Clavien-Dindo grade 3a complication, 7 positive margins among 41 patients, and 4 biochemical recurrences at 42 months. Newer evidence supported feasibility but highlighted competing mortality and careful selection. Conclusions: Robot-assisted radical prostatectomy is feasible and generally graft-safe in selected kidney transplant recipients when performed by experienced robotic teams familiar with transplant anatomy. Unresolved questions concern patient selection, pelvic lymph node dissection strategy, standardized functional reporting, transplant-specific graft endpoints, and prospective multicenter data collection.
