You’ve heard of – and, perhaps, stopped into – all-night diners, fitness centers, grocery stores, and gas stations. Now joining them in delivering 24/7 service: all-night robotic kidney transplants at UCHealth University of Colorado Hospital on the Anschutz Medical Campus.

UCHealth hospitals are round-the-clock operations anyway, and surgeons and their teams are well known for flouting circadian rhythms in the interest of patient care. The expansion of robotic-surgery operating hours is about enabling kidney transplants for people whose weight otherwise prevented them from life-changing – and, often lifesaving – surgeries.

Gerald Paity, 52, was one of those people. The Denver resident was among the 9.7% of U.S. adults who, as of 2023, had BMIs of 40 or above, a 25% increase over a decade earlier. A high BMI is a major risk factor in developing f chronic kidney diseases that can lead to dialysis and the need for a kidney transplant. At the same time, someone with a BMI over 40 has a roughly 30% higher risk of kidney-transplant failure after open surgery than someone with a BMI of 25 – often because of surgical-site healing problems. (A 5’9” adult male with a BMI of 25 weighs about 170 pounds; with a BMI of 40, he weighs about 270.)

Nine years on the kidney-transplant list because of high BMI

Paity, who is six feet tall, weighed 410 pounds with failing kidneys in 2011 when he opted for bariatric surgery to drop enough weight to be eligible for open kidney transplant surgery. He lost nearly 200 pounds. He started home-based peritoneal dialysis in 2015 and, two years later, hemodialysis three times a week at a dialysis center. He was listed for a kidney transplant, but his weight kept him far from the top. Even with a bariatric-surgery revision in 2021, attempts at exercising more, and a physical job working nights in a warehouse, he couldn’t get his weight down to the 250 pounds that doctors at a Denver-area community hospital were pushing for.

“I was at 250 in high school,” Paity said. “I was trying and trying. And then Covid hit, and I wasn’t able to go to the gym, so I was just trying to keep my weight down by walking. There was no way possible.”

It’s a familiar story, says University of Colorado School of Medicine transplant surgeon Dr. Thomas Pshak.

“When you’re tethered to a dialysis machine, and your energy level is horrible, and you’re dealing with muscle-wasting, it’s virtually impossible to ask someone to lose 50 pounds,” Pshak said.

Surgical robots make kidney transplants possible for high-BMI patients

Pshak was in a position to do something for Paity and other high-BMI patients in similar straits. In late 2022, Pshak performed the first successful robotic kidney transplant west of the Mississippi using a surgical robot on a high-BMI patient. Since then, he had done the same for about 50 other high-BMI patients.

Transplant surgeons Dr. Trevor Nydam and Dr. Phillipe Abreu, Gerald Paity, and transplant surgeon Dr. Thomas Pshak. Photo courtesy of Gerald Paity.

Robotic surgery enables small incisions, easy access, and precise suturing of blood vessels involved in a kidney transplant regardless of body weight. Pshak has done robotic transplants on patients with BMIs as high 58.

“With the robot, it really doesn’t matter what your BMI is,” Pshak said. “The robot allows us to do surgery as if they had a BMI of 15.”

But the hurdle of robotic-surgery capacity remained. High-BMI patients ineligible for open surgery only had the option of robotic surgery. But given limited capacity in UCHealth’s robotic-surgery suites, only those high-BMI patients who could line up a living donor (which lets you schedule the procedure well in advance) were able to go through with a transplant.

Making all-night robotic kidney-transplant surgery happen so more people can get transplants

Pshak saw that, if the transplant team had nighttime access to robotic surgery suites – which are used for various procedures – they could add enough robotic-surgery capacity to open up deceased-donor kidney transplants to high-BMI patients. (Deceased-donor kidney transplants happen impromptu, typically within 24 hours of a matched kidney becoming available.) Fellow CU School of Medicine transplant surgeons Dr. Trevor Nydam and Dr. Phillipe Abreu, who with Pshak would lead and support the late-night surgeries, agreed.

Robotic surgery is a team effort, and despite the prospects of more night-shift procedures, nurses, technologists, anesthesiologists, and others involved the complex choreography of robotic surgery were fully on board. UCHealth leadership also supported the idea.

“We have all the tools, we have the skill, and we have the team, but it was really the administration, both in the OR and in the C-suite, that really is allowing us to do this and transplant many people who otherwise were denied for many years,” Pshak said.

To the top of the deceased-donor kidney-transplant list

Paity was among the first beneficiaries. A friend at the dialysis center who had also waited for years told Paity he was suddenly high on the deceased-donor list at UCHealth University of Colorado Hospital. Paity switched hospitals, went in for testing, and, because he had been on the kidney-transplant waitlist for nine years, soon found himself at the top of it. Weeks later, on September 12, his number came up. The surgery was a success.

“I just feel like I’m back to my old self,” he said. “I have way better energy and all that. It’s awesome. I thought I was going to be on dialysis the rest of my life.”

Pshak says high-BMI-patient access to deceased-donor kidney transplant surgery is a big win for patients who have long been denied the surgery in Colorado – and beyond.

“It’s a game-changer for patients all across the country who may be trying to get a kidney transplant, but they’ve been denied because of their BMI,” he said. “Now, even if you’re not in Colorado, we can list you in Colorado, and, as long as you can take a flight here, once you get an organ offer, we’re able to transplant you.”

Paity wants to help get the word out.

“There’s a lot of people I’ve been with in dialysis who can’t get a transplant because of their size,” he said. “Now that this is in play, I’m glad I can talk about it to let people know it is possible.”