Teen Becomes First Pediatric Patient To Undergo Single-Port Robotic-Assisted Kidney Transplant

Riley Black is enjoying being a teenager again after more than a year of grappling with a rare kidney disease that put her life on hold.

"I had to stop sports and miss football games. I couldn’t really hang out with my friends either because I was on dialysis and always tired,” says 17-year-old Riley of Parma, Ohio.

In 2023, Riley was diagnosed with complement 3 glomerulopathy (C3G), which refers to a group of conditions that affect how well the kidneys work. After her diagnosis, she went on to become the first pediatric patient in the world to undergo a single-port robotic-assisted kidney transplant.

“From reducing pain to shortening hospital stays, our priority is using all the latest tools available to improve patient outcomes. This includes the use of robotics in pediatric cases when appropriate,” says Alvin Wee, MD, the program director of Renal Transplantation at Cleveland Clinic.

Riley’s health journey began in July 2023, when she started experiencing concerning symptoms. “We noticed I was really pale, and it seemed like I was always sleeping. I felt like something was off, so we made an appointment with my doctor,” says Riley.

Riley’s doctor ordered initial blood work that showed her creatinine levels were elevated, which can indicate kidney issues. She was also experiencing high blood pressure and anemia. The results from her initial workup were alarming enough that she was hospitalized.

“Pretty much immediately after getting the blood work, I had to go to the emergency department. It was just a lot at once and very overwhelming,” says Riley.

Further testing, including a kidney biopsy, confirmed she had a type of C3G called C3 glomerulonephritis.

“C3 stands for complement 3 – it’s a protein in your blood that’s important for your immune system. If it's under good control, it can help fight off certain types of infections. But if it's not regulated appropriately, it can damage the kidneys,” says Amy Bobrowski, MD, a pediatric nephrologist with Cleveland Clinic Children’s.

If you have C3G, part of your immune system called the complement system is too active. This causes C3 proteins to build up in the filtering units of your kidneys called glomeruli, making it harder for them to filter blood and make urine. Without treatment, this will ultimately lead to kidney damage and potentially kidney failure.

As in many cases, Dr. Bobrowski says it’s unclear exactly why Riley developed this rare condition that’s estimated to affect two to three out of every 1 million people. While there are currently no FDA-approved treatment options specifically for C3G, there are a number of treatments or supportive therapies to slow the progression and manage symptoms.

“From the initial biopsy, we could already see a lot of scarring and chronic changes to her kidney, so we knew eventually she would likely need a kidney transplant,” says Dr. Bobrowski.

But before moving forward with a transplant, Riley’s care team wanted to improve her overall condition as much as possible. She started out on different medicines to suppress her overactive immune system and needed multiple blood transfusions in addition to medications to treat her anemia.

“I switched to online schooling shortly after my diagnosis. It was hard for me to keep up with everything and undergo my treatments,” says Riley, who also couldn’t play volleyball or basketball anymore.

Riley eventually went on hemodialysis, which is a type of dialysis that uses a machine to perform the kidneys’ normal function of filtering waste products and excess fluids from the blood. She continued this for seven months until her care team determined it was the optimal time for transplant.

“The day Riley’s doctors told us she was ready for a kidney transplant, I knew I wanted to be the organ donor. I wanted to make sure she was able to get the transplant as soon as possible,” says Riley’s mom, Lisa Black.

Lisa's hope to be able to help her daughter became a reality when testing confirmed she was a donor match.

“When the transplant coordinator called to tell me I was a match, I screamed with glee. It was the best day of my life,” says Lisa.

Riley adds, “Finding out my mom was a match felt like it was meant to be – it was a great day.”

With a donor kidney confirmed, the next step was planning the best surgical approach for Riley.

“Over the years, there have been exponential advancements in transplant. In the beginning, an open procedure was our only surgical option. Now we have laparoscopic and robotic-assisted kidney transplants as well. There is a wide range of surgical approaches to choose from," says urologic surgeon Mohamed Eltemamy, MD.

Riley’s care team determined she would be a good candidate for a robotic-assisted kidney transplant, which can be performed using a single or multi-port approach. A multi-port robotic transplant involves multiple small incisions – while a single-port involves one small incision.

“Each patient is different, and there are many variables we consider when deciding the best surgical option for them. In Riley’s case, we determined a single-port approach would be most beneficial. Since this technique requires just one small incision, it results in reduced pain, a quicker recovery and minimal scarring, which is especially important for our pediatric patients,” says Dr. Eltemamy.

The robotic technique is less often used for pediatric patients because they’re smaller in size, making the surgery more challenging. “We were able to offer this option to Riley because of our experience with the approach as well as robotic surgeries in general,” adds Dr. Eltemamy, the lead robotic transplant surgeon.

In September 2024, Riley and her mom both underwent successful single-port robotic surgeries. Lisa was home within two days after her surgery with Dr. Wee, and Riley was home with minimal pain a week after her surgery with Dr. Eltemamy.

Following her transplant, Riley’s kidney function drastically improved to near normal, and she no longer needs to be on dialysis. Although there’s no cure for C3G right now, she’s currently in remission with no evidence of the disease at this time. Since there is a risk of recurrence, she’ll continue to be closely monitored.

“To see Riley off dialysis with a good functioning kidney is amazing. She’s like a different kid, and it goes to show how the altruistic act of organ donation can make such a huge difference in someone’s life,” says Dr. Bobrowski.

Riley is now back to playing sports and spending time with her friends. She’s also looking forward to being able to return to school in person for her senior year.

“I couldn’t make it to homecoming, but I’m glad I won’t miss prom next year,” says Riley, who’s also looking forward to college and plans on studying film.

Lisa adds, “Riley was able to celebrate her most recent birthday with friends, and we have a summer vacation planned. We're getting out and doing all these things we had to put on pause when Riley got sick.”

Reflecting on her journey, Riley says she’s grateful for her care team, her mom and the new lease on life the power of organ donation has given her.

“When I got sick, I felt left out all the time. But after my kidney transplant, I’m back to doing all the things I love again. Be patient and never lose faith or hope no matter what you're going through,” says Riley.