Robotic Liver Transplantation in Recipients with Obesity

Abstract Introduction: Robotic liver transplantation (RLT) is an emerging minimally invasive approach, but experience in recipients with obesity remains limited. This study describes the operative strategy and short-term outcomes of deceased-donor whole-graft RLT in recipients with body mass index (BMI) ≥ 30 kg/m². Methods This retrospective single-center case series included consecutive recipients with obesity who underwent deceased-donor whole-graft RLT between January 2024 and April 2026. Perioperative and postoperative outcomes included conversion, ischemia times, intensive care unit (ICU) and hospital stay, postoperative complications, wound- and access-related morbidity, 90-day early allograft failure (EAF), mortality, and graft survival. Results Ten recipients underwent RLT. Median BMI was 31 kg/m² (IQR, 30–34.9), and 2 patients had Obesity ≥ III. Median MELD score was 10 (IQR, 7–15.8). Four grafts were procured from donation after circulatory death donors, and machine perfusion was used in 9 cases. Median operative time was 577.5 minutes (IQR, 570–656.25), estimated blood loss was 1150 mL (IQR, 500–2700), cold ischemia time was 320.5 minutes (IQR, 284.25–348.5), and warm ischemia time was 50 minutes (IQR, 44.75–58). No conversion to open surgery was required. Median ICU and hospital stay were 1 and 6 days, respectively. Within 90 days, 2 patients required readmission and reoperation. No 30- or 90-day mortality and no EAF occurred. At 5.3 months, all patients were alive with functioning grafts. Conclusion Deceased-donor whole-graft RLT was feasible without conversion and with acceptable short-term outcomes in recipients with obesity.