Introduction: Robot assisted radical prostatectomy (RARP) remains an effective and safe treatment modality for adenocarcinoma of the prostate, and requires different technical considerations in the setting of solid organ transplantation. Our objective is to describe perioperative outcomes, complications, and disease progression in patients with solid organ transplant following RARP.
Methods: We analyzed all prostatectomies performed on patients with solid organ transplantations at our institution since the inception of the procedure. We included patients with solid organ transplants in situ at the time of RARP. Patient demographics, preoperative indications, postoperative outcomes, pathologic outcomes, and immunosuppression regimens were analyzed.
Results: Two-thousand, two hundred and thirty patients underwent RARP at our institution from January 2003-May 2019. There were twenty patients with solid organ transplants at the time of prostatectomy, including ten kidney transplants, seven liver transplants, and three heart transplants. The median time from transplantation to RARP was 52 months, and median follow up post-prostatectomy was 55 months. Procedures lasted a median of 241 (195-283) minutes. Alterations to the standard RARP procedure were described in twelve patients. The median estimated blood loss was 100 (100-175) milliliters, and median length of stay was 1 night. All patients experienced an undetectable PSA postoperatively, with one patient experiencing biochemical relapse, who also had a positive surgical margin. Complications occurred in four patients, with the two most significant occurring in liver transplant patients on anticoagulation: these included a perirectal hematoma with resulting urine leak, and a thromboembolic event. There were no fascial dehiscences or wound infections in our series.
Conclusions: In conclusion, RARP is a technically feasible option in appropriately selected solid organ transplant patients. This represents the largest robot assisted prostatectomy series in solid organ transplant patients to date. Although this represents a limited series, we did not observe an increased rate of infection, dehiscence, or biochemical relapse in the setting of immunosuppression. Source of