Obesity has been reported as risk factor for reduced posttransplant graft and patient survival and increased delayed graft function (DGF).
Objective:
The purpose of this work is to analyze the effect of body mass index (BMI) on defined transplant outcomes in patients transplanted under defined guidelines in a kidney transplant program.
Design:
Review of a prospectively collected database in renal transplant recipients receiving rabbit antithymocyte globulin induction, mycophenolate mofetil, tacrolimus, and early corticosteroid withdrawal between 2001 and 2011.
Setting:
This review was conducted in a single abdominal transplant program in the United States.
Main Outcome Measures:
Primary outcome was death-censored graft survival categorized by posttransplant body mass groups. Secondary outcomes included DGF as well as patient survival.
Results:
Four hundred sixty seven patients were identified. No difference was observed in graft survival or DGF between BMI groups. One-year, death-censored graft survival and patient survival rates ranged from 97.5% to 100% and 96.6% to 100%, respectively. Delayed graft function was uncommon across all BMI groups, ranging from 5.3% to 9.1%, with the lowest incidence in patients with a BMI ≥ 35 kg/m2. Biopsy-proven acute rejection rates at 1 year were similar across all groups (10.1%-14%) as were estimated glomerular filtration rates were at 1, 3, and 5 years.
Conclusion:
Our results do not show an effect of BMI on posttransplant outcomes, suggesting that relaxation of BMI criteria may be warranted for recipient selection.
HolleyJLShapiroRLopatinWBTzakisAGHakalaTRStarzlTE. Obesity as a risk factor following cadaveric renal transplantation. Transplantation. 1990;49(2):387–389.
2.
LynchRJRanneyDNShijieCLeeDSSamalaNEnglesbeMJ. Obesity, surgical site infection, and outcome following renal transplantation. Ann Surg. 2009;250(6):1014–1020. doi:10.1097/SLA.0b013e3181b4ee9a.
3.
KuoJHWongMSPerezRVLiCSLinTCTroppmannC. Renal transplant wound complications in the modern era of obesity. J Surg Res. 2012;173(2):216–223. doi:10.1016/j.jss.2011.05.030.
4.
SegevDLSimpkinsCEThompsonRELockeJEWarrenDSMontgomeryRA. Obesity impacts access to kidney transplantation. J Am Soc Nephrol. 2008;19(2):349–355.
5.
PatibandlaBKNarraADeSilvaRChawlaVGoldfarb-RumyantzevAS. Access to renal transplantation in the diabetic population–effect of comorbidities and body mass index. Clin Transplant. 2012;26(3):E307–E315. doi:10.1111/j.1399-0012.2012.01661.x.
6.
GillJSLanJDongJ. The survival benefit of kidney transplantation in obese patients. Am J Transplant. 2013;13(8):2083–2090. doi:10.1111/ajt.12331.
7.
KramerHJSaranathanALukeA. Increasing body mass index and obesity in the incident ESRD population. J Am Soc Nephrol. 2006;17(5):1453–1459.
8.
ChangSHCoatesPTMcDonaldSP. Effects of Body mass index at transplant on outcomes of kidney transplantation. Transplantation. 2007;84(8):981–987.
9.
MarcénRFernándezAPascualJ. High body mass index and posttransplant weight gain are not risk factors for kidney graft and patient outcome. Transplant Proc. 2007;39(7):2205–2207.
10.
Abou-JaoudeMMNawfalNNajmRHoneidiMShaheenJAlmawiWY. Effect of pretransplantation body mass index on allograft function and patient survival after renal transplantation. Transplant Proc. 2010;42(3):785–788. doi:10.1016/j.transproceed.2010.03.026.
11.
DitonnoPLucarelliGImpedovoSV. Obesity in kidney transplantation affects renal function but not graft and patient survival. Transplant Proc. 2011;43(1):367–372. doi:10.1016/j.transproceed.2010.12.022.
12.
FurrielFParadaBCamposL. Pretransplantation overweight and obesity: does it really affect kidney transplantation outcomes?Transplant Proc. 2011;43(1):95–99. doi:10.1016/j.transproceed.2010.12.027.
13.
BardonnaudNPillotPLillazJ. Outcomes of renal transplantation in obese recipients. Transplant Proc. 2012;44(9):2787–2791. doi:10.1016/j.transproceed.2012.09.031.
14.
MoreiraTRBassaniTde SouzaGManfroRCGonçalvesLF. Obesity in kidney transplant recipients: association with decline in glomerular filtration rate. Ren Fail. 2013;35(9):1199–1203. doi:10.3109/0886022X.2013.819735.
15.
PapaliaTGrecoRLofaroDMaestripieriSMancusoDBonofiglioR. Impact of body mass index on graft loss in normal and overweight patients: retrospective analysis of 206 renal transplants. Clin Transplant. 2010;24(6):E241–E246. doi:10.1111/j.1399-0012.2010.01258.x.
16.
HoogeveenEKAaltenJRothmanKJ. Effect of obesity on the outcome of kidney transplantation: a 20-year follow-up. Transplantation. 2011;91(8):869–874. doi:10.1097/TP.0b013e3182100f3a.
17.
MolnarMZKovesdyCPMucsiI. Higher recipient body mass index is associated with post-transplant delayed kidney graft function. Kidney Int. 2011;80(2):218–224. doi:10.1038/ki.2011.114.
18.
WangKLiuQZ. Effect analysis of 1-Year posttransplant body mass index on chronic allograft nephropathy in renal recipients. Transplant Proc. 2011;43(7):2592–2595. doi:10.1016/j.transproceed.2011.04.022.
19.
CannonRMJonesCMHughesMGEngMMarvinMR. The impact of recipient obesity on outcomes after renal transplantation. Ann Surg. 2013;257(5):978–984. doi:10.1097/SLA.0b013e318275a6cb.
20.
CurranSPFamureOLiYKimSJ. Increased recipient body mass index is associated with acute rejection and other adverse outcomes after kidney transplantation. Transplantation. 2014;97(1):64–70. doi:10.1097/TP.0b013e3182a688a4.
21.
U.S. Renal Data System, USRDS 2013 Annual Data Report: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2013.
22.
GrossoGCoronaDMistrettaA. The role of obesity in kidney transplantation outcome. Transplant Proc. 2012;44(7):1864–1868. doi:10.1016/j.transproceed.2012.06.043.
23.
BehzadiAHKamaliKZargarMAbbasiMAPiranPBastaniB. Obesity and urologic complications after renal transplantation. Saudi J Kidney Dis Transpl. 2014;25(2):303–308.
24.
SiedleckiAIrishWBrennanDC. Delayed graft function in the kidney transplant. Am J Transplant. 2011;11(11):2279–2296. doi:10.1111/j.1600-6143.2011.03754.x.
25.
SalahudeenAKHaiderNMayW. Cold ischemia and the reduced long-term survival of cadaveric renal allografts. Kidney Int. 2004;65(2):713–718.
26.
OlarteIGHawasliA. Kidney transplant complications and obesity. Am J Surg. 2009;197(3):424–426. doi:10.1016/j.amjsurg.2008.11.021.
27.
SharmaAKTolaniSLRathiGLSharmaPGuptaHGuptaR. Evaluation of factors causing delayed graft function in live related donor renal transplantation. Saudi J Kidney Dis Transpl. 2010;21(2)242–245.
28.
HellegeringJVisserJKlokeHJ. Deleterious influence of prolonged warm ischemia in living donor kidney transplantation. Transplant Proc. 2012;44(5):1222–1226. doi:10.1016/j.transproceed.2012.01.118.
29.
HellegeringJVisserJKlokeHJ. Poor early graft function impairs long-term outcome in living donor kidney transplantation. World J Urol. 2013;31(4):901–906. doi:10.1007/s00345-012-0835-z.
30.
PatelSPankewyczOKohliR. Obesity in renal transplantation: the role of induction therapy on long-term outcomes. Transplant Proc. 2011;43(2):469–471. doi:10.1016/j.transproceed.2011.01.040.
31.
AlexanderJWGoodmanHRGersinK. Gastric bypass in morbidly obese patients with chronic renal failure and kidney transplant. Transplantation. 2004;78(3):469–474.
32.
AlexanderJWGoodmanH. Gastric bypass in chronic renal failure and renal transplant. Nutr Clin Pract. 2007;22(1):16–21.
33.
RogersCCAllowayRRAlexanderJWCardiMTrofeJVinksAA. Pharmacokinetics of mycophenolic acid, tacrolimus and sirolimus after gastric bypass surgery in end-stage renal disease and transplant patients: a pilot study. Clin Transplant. 2008;22(3):281–291. doi:10.1111/j.1399-0012.2007.00783.x.
