 A key issue arising from MIKT is its effect on the kidney allograft. The robotic kidney transplant technique prolongs the re-warming time due to the longer anastomosis time. Results suggest that this may reduce the glomerular filtration rate eGFR in the early post-transplant period when compared to open kidney transplant with no difference in function at 1 and 2 year follow-up. The long-term consequences for the graft beyond this period are unknown. The effects of pneumoperitoneum on the transplant kidney have also been questioned with suggestions that higher intra-abdominal pressures may reduce allograft perfusion during surgery with negative consequences for the allograft based on experience with other studies of both human and animal models. There is unpublished data that suggests that the effects on longer term graft outcomes are not significant. 