To compare perioperative and early follow-up outcomes between robot-assisted kidney transplantation (RAKT) and open kidney transplantation (OKT), based on propensity-matched cohort studies.

A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD42022334583). We included studies comparing RAKT and OKT using propensity-score matching. Outcomes assessed included surgical parameters, complications, graft function, and patient survival.

Seven studies were included, comprising 1,263 kidney transplant recipients (517 RAKT and 919 OKT). RAKT was associated with significantly shorter incision length (SMD = –9.00, p < 0.001), fewer overall postoperative complications (RR = 0.52, p = 0.024), and fewer Clavien–Dindo grade III–IV complications (RR = 0.58, p = 0.013). However, RAKT resulted in longer warm ischemia time (SMD = 0.66, p < 0.001), cold ischemia time (SMD = 0.96, p = 0.011), rewarming time (SMD = 3.08, p = 0.053), and total ischemia time (SMD = 1.73, p = 0.054). No significant differences were observed in intraoperative complications, delayed graft function, reoperation rates, or 1-year recipient survival. Graft survival at 1 year was slightly higher in the RAKT group (RR = 1.01, p = 0.031), with adjusted analyses showing a modest advantage (RR = 1.03, p = 0.001).

RAKT offers certain perioperative benefits, particularly in reducing surgical trauma and complications. However, it does not demonstrate clear superiority over OKT in terms of graft or patient survival at 1 year. Its application remains limited to specialized centers, and further high-quality, long-term studies are needed to evaluate its broader clinical value and cost-effectiveness.