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Selçuk Topbaş S, Sarıgöl Ordin Y. Investigation of Weight Gain and Affecting Factors in Kidney Transplant Recipients in the First 2 Years After Transplant. EXP CLIN TRANSPLANT 2024; 22:200-206. [PMID: 35607798 DOI: 10.6002/ect.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES It is necessary to examine weight gain and affecting factors after kidney transplant. This study was performed to examine weight gain and affecting factors in kidney transplant recipients in the first 2 years after transplant. MATERIALS AND METHODS This descriptive cross-sectional study included 139 kidney transplant recipients who were regularly followed by 2 university hospitals in the first 2 years after transplant. Data were collected with the use of a sociodemographic and clinical features' form and the General Self-Efficacy Scale. Weight and body mass index at 3, 6, 12, and 24 months after transplant were evaluated. Differences between weight (in kilograms) and body mass index (in kilograms divided by height in meters squared) at the first outpatient clinic visit and weight and body mass index at 24 months after transplant were calculated. RESULTS The mean age of patients was 46.32 ± 12.39 years. Differences in mean weight and body mass index between the first posttransplant outpatient clinic visit and at month 24 posttransplant were 7.07 ± 7.57 and 2.6 ± 2.37, respectively. Statistically significant differences were found in weight and body mass index at 2 years posttransplant. As age increased, weight gain decreased. Differences in weight gain and body mass index were not significantly associated with sex, presence of chronic diseases, donor type, steroid dose, and self-efficacy. CONCLUSIONS Kidney transplant recipients in our study population had increased weight and body mass index at 2 years after transplant. Younger kidney transplant recipients had higher weight gains. Therefore, kidney transplant recipients, especially younger ones, should be closely followed in terms of weight gain after transplant.
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Affiliation(s)
- Sedef Selçuk Topbaş
- From Metin Sabanci Bone Diseases Training and Research Hospital, Istanbul, Turkey
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Prudhomme T, Bento L, Frontczak A, Timsit MO, Boissier R. Effect of Recipient Body Mass Index on Kidney Transplantation Outcomes: A Systematic Review and Meta-analysis by the Transplant Committee from the French Association of Urology. Eur Urol Focus 2023:S2405-4569(23)00246-8. [PMID: 37993345 DOI: 10.1016/j.euf.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
CONTEXT The impact of recipient obesity on kidney transplantation (KT) outcomes remains unclear. OBJECTIVE The aim of this study was to perform a systematic review and meta-analysis to appraise all available evidence on the outcomes of KT in obese patients (body mass index [BMI] ≥30 kg/m2) versus nonobese patients (BMI <30 kg/m2). EVIDENCE ACQUISITION A systematic review and meta-analysis was performed. Search was conducted in the MEDLINE OvidSP, Web of Science, Google Scholar, Embase, and Cochrane databases to identify all studies reporting the outcomes of KT in obese versus nonobese recipients. EVIDENCE SYNTHESIS Fifty-two articles met the inclusion criteria. Delayed graft function and surgical complications were significantly higher in obese recipients (delayed graft function: relative risk [RR]: 1.44, 95% confidence interval [CI]: 1.32-1.57, p < 0.01; surgical complications: RR: 1.74, 95% CI: 1.36-2.22, p < 0.0001). Five-year patient survival (RR: 0.96, 95% CI: 0.92-1.00, p = 0.01), 10-yr patient survival (RR: 0.90, 95% CI: 0.84-0.97, p = 0.006), and 10-yr graft survival (RR: 0.87, 95% CI: 0.79-0.96, p = 0.01) were significantly inferior in the obese group. CONCLUSIONS KT in obese recipients was associated with lower patient and graft survival, and higher delayed graft function, acute rejection, and medical and surgical complications than nonobese recipients. In the current situation of organ shortage and increasing prevalence of obesity, ways to optimize KT in this setting should be investigated. PATIENT SUMMARY Compared with nonobese population, kidney transplantation in obese recipients has inferior patient and graft survival, and higher medical and surgical complications.
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Affiliation(s)
- Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France.
| | - Lucas Bento
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Alexandre Frontczak
- Department of Urology and Kidney Transplantation, Besançon University Hospital, Besançon, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Boissier
- Department of Urology and Kidney Transplantation, Conception University Hospital, Aix-Marseille University, Marseille, France
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Herrera S, Carbonell I, Cofan F, Cucchiari D, Abalde I, Bernabeu E, Sempere A, Peri L, Revuelta I, Diekmann F, Alcaraz A, Musquera M, Bodro M. Impact of robotic-assisted kidney transplantation on post-transplant infections: a case-control study. World J Urol 2023; 41:2847-2853. [PMID: 37477683 DOI: 10.1007/s00345-023-04484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/07/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The aim of this study was to determine the differences in the incidence, epidemiology, clinical characteristics and risk factors of infections in living donor kidney transplant recipients using robotic-assisted kidney transplantation (RAKT) and open approach. METHODS We conducted a retrospective observational study from January 2016 to December 2019. For the risk factor analysis, a matched case-control study (1:1 ratio) was performed (robotic vs open). Control subjects were matched for living donor and time of transplantation. The data included de novo immunosuppressive regimen, delayed graft function, urological complications, acute allograft rejection and incidence, clinical features, microbiological findings and outcomes of infections. RESULTS Ninety-four RAKT and 84 controls were included. There were no differences between groups in terms of age, gender, BMI, median days of hospitalization, immunosuppressive regimen, need for surgical urologic procedures post-transplantation, presence of urinary leak or acute allograft rejection. Thirty-five percent of all recipients analyzed presented an infection, mostly asymptomatic bacteriuria (49%), symptomatic urinary tract infection (31%) and surgical site infection (10%). Pseudomonas aeruginosa was the most frequent isolated microorganism in 67%, followed by E. coli (20%), Enterococcus faecalis (17%) and Klebsiella pneumoniae (10%). Eight percent of the microorganisms were multidrug resistant. The open kidney transplantation group presented more infections compared to RAKT (43 vs 27%, p = 0.04). After multivariate analysis, need for surgical urologic procedure post-transplantation (OR 6.2, 95% CI 1.1-35), BMI ≥ 30 (OR 3.6, 95% CI 1.5-9) and acute allograft rejection (OR 3.2, 95% CI 1.2-8.5) were associated with infection, whereas RAKT (OR 0.5, 95% CI 0.2-0.9) and the use of JJ catheter (OR 0.36, 95% CI 0.17-0.72) were protective factors. CONCLUSIONS Infection is a frequent event in patients receiving a living donor kidney transplant. Acute allograft rejection, need for surgical urologic procedure post-transplantation and BMI were associated with infection, whereas robotic surgery was a protective factor in living donor kidney transplantation.
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Affiliation(s)
- Sabina Herrera
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Irene Carbonell
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Frederic Cofan
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - David Cucchiari
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Iolanda Abalde
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Emilia Bernabeu
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Abiu Sempere
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Lluís Peri
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Ignacio Revuelta
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Fritz Diekmann
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Antonio Alcaraz
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Mireia Musquera
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Marta Bodro
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
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Moein M, Otero MT, Rood GJ, Hanlon M, Saidi R. Kidney Transplantation and Obesity: Are There Any Differences in Outcomes? World J Surg 2023; 47:510-518. [PMID: 36264336 DOI: 10.1007/s00268-022-06806-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Kidney transplantation (KT) is the gold standard treatment for end-stage renal disease (ESRD) patients. Obesity is a strong risk factor for developing cardiovascular disease, chronic kidney disease, and ESRD. This study aimed to investigate the outcomes of kidney transplantation in obese recipients. MATERIAL AND METHODS We retrospectively reviewed the medical records of recipients from January 2016 to December 2021 in a single center. Outcomes in recipients of a kidney allograft with BMI ≥ 30 were compared with the outcomes in recipients with 30 < BMI. RESULTS A total of 467 consecutive kidney transplantation recipients' files were studied. 213 (45.6%) allograft recipients had a BMI ≥ 30, and 254 (54.4%) allograft recipients had a BMI < 30. DGF rate was 29.1% in the BMI ≥ 30 and 30.7% in the BMI < 30 group (P = 0.41). On the other hand, 30 days readmission rate also did not show a significant difference between the BMI ≥ 30 and BMI < 30 allograft recipients (37 vs. 33.8%, P = 0.46). The mean overall costs of transplantation in the BMI ≥ 30 group was $254,395, and it was $256,029 in the BMI < 30 group (P = 0.84). CONCLUSION Our study shows that the outcomes of renal allograft transplant were comparable between recipients with BMI ≥ 30 and BMI < 30 in terms of DGF, LOS, 30 days readmission, acute rejection rate, and survival rates, and BMI should not be a single independent criterion for decision making to select an optimal recipient.
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Affiliation(s)
- Mahmoudreza Moein
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Melanie Tacher Otero
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Gavrielle J Rood
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Matthew Hanlon
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA
| | - Reza Saidi
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, 13210, USA.
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Ishikawa S, Tasaki M, Ikeda M, Nakagawa Y, Saito K, Tomita Y. Pretransplant BMI Should Be <25 in Japanese Kidney Transplant Recipients: A Single-Center Experience. Transplant Proc 2023; 55:72-79. [PMID: 36528408 DOI: 10.1016/j.transproceed.2022.10.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/24/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to determine the appropriate body mass index (BMI) in Japanese kidney transplant (KTx) recipients. We analyzed the effects of pre- and post-transplant (Tx) obesity on graft and patient survival, perioperative complications, post-transplant diabetes mellitus (PTDM), and cardiovascular disease (CVD) in Japanese KTx recipients. METHODS This retrospective study included 269 recipients who underwent KTx from 2008 through 2020 at Niigata University Hospital. Obesity was defined as a body mass index (BMI) ≥25 kg/m2. We examined the association between pre- and post-Tx obesity and graft survival, patient survival, the incidence of PTDM and CVD, and perioperative surgical complications. RESULTS The graft survival rate was lower in the pre-Tx BMI ≥25 kg/m2 group, although there was no significant difference in patient survival. There was no difference in graft and patient survival between the post-Tx BMI ≥25 kg/m2 group and the <25 kg/m2 group. A pre-Tx BMI ≥25 kg/m2 was an independent risk factor for biopsy-proven allograft rejection. New-onset DM after transplantation was significantly more common in the BMI ≥25 kg/m2 group than in the BMI <25 kg/m2 group (36% vs 13%; P = .002). The incidence of CVD was significantly higher in the post-Tx BMI ≥30 kg/m2 group than in the BMI <30 kg/m2 group (50% vs 11%; P = .023). There were no differences in surgical operating time, intraoperative blood loss, or perioperative complications between the obese and non-obese groups. CONCLUSION Pre-Tx BMI ≥25 kg/m2 may be a risk factor for allograft rejection and graft loss. Post-Tx BMI should be <25 kg/m2 to reduce the risk for PTDM.
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Affiliation(s)
- Shoko Ishikawa
- Department of Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Masayuki Tasaki
- Department of Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masahiro Ikeda
- Department of Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuki Nakagawa
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhide Saito
- Department of Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yoshihiko Tomita
- Department of Urology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Yemini R, Rahamimov R, Nesher E, Anteby R, Ghinea R, Hod T, Mor E. The Impact of Obesity and Associated Comorbidities on the Outcomes after Renal Transplantation with a Living Donor vs. Deceased Donor Grafts. J Clin Med 2022; 11:jcm11113069. [PMID: 35683458 PMCID: PMC9181095 DOI: 10.3390/jcm11113069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Obesity among kidney transplant (KT) recipients can lead to metabolic comorbidity-associated deaths. This study compares post-KT survival between obese and non-obese patients and outcomes of living donor (LD) and deceased donor (DD) grafts. Methods: Between January 2005−May 2019, 1403 KT recipients from a single center were included in the study, as well as 314 patients (22.4%) with obesity (BMI > 30 kg/m2), 137 DD transplants, and 177 LD transplants. Of the 1089 (77.6%) in the control group (BMI ≤ 30 kg/m2), 384 were DD transplants and 705 LD transplants. The Kaplan−Meier method was used for survival analysis and a Cox regression was used to identify risk factors for graft loss and mortality. Propensity score matching analysis adjusting for age, IHD, and T2DM was performed. Results: The study group had higher incidence of obesity related comorbidities, delayed graft function and primary non function (p < 0.001). One-, 5-and 10-year patient and graft survival were lower in the study group (p < 0.001). Subgroup analysis of graft survival according to type of graft shows a difference in the DD (p = 0.002) but not in the LD group (p = 0.220). However, mortality was higher in both groups (LD, p = 0.045; DD, p = 0.004). Risk factors for mortality were age, T2DM, IHD, and DD, and for graft failure: IHD, BMI, donor age, re-transplant, and DD. Propensity score analysis shows an odds ratio of 0.81 for graft failure and 0.93 for death in the study group (95% CI = 0.55, 1.21, p = 0.3 and CI = 0.59, 1.46, p = 0.7, respectively). Conclusions: Recipient age and metabolic comorbidities should be emphasized when evaluating patients with obesity. We suggest considering weight loss interventions using the new GLP-1 inhibitors and bariatric procedures in selected patients to prepare overweight patients for transplant.
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Affiliation(s)
- Renana Yemini
- Department of Surgery, Samson Assuta Ashdod University Hospital, Ashdod 7747629, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva 8410501, Israel
- Correspondence: ; Tel.: +972-72-3398884; Fax: +972-72-3398916
| | - Ruth Rahamimov
- Institute of Nephrology, Beilinson Medical Center, Petach-Tikva 49100, Israel;
- Sackler Medical School, Tel-Aviv University, Tel Aviv 6997801, Israel; (E.N.); (R.A.); (R.G.); (T.H.); (E.M.)
| | - Eviatar Nesher
- Sackler Medical School, Tel-Aviv University, Tel Aviv 6997801, Israel; (E.N.); (R.A.); (R.G.); (T.H.); (E.M.)
- Department of Transplant Surgery, Beilinson Medical Center, Petach-Tikva 49100, Israel
| | - Roi Anteby
- Sackler Medical School, Tel-Aviv University, Tel Aviv 6997801, Israel; (E.N.); (R.A.); (R.G.); (T.H.); (E.M.)
- Transplant Center, Department of Surgery B, Sheba Medical Center, Ramat Gan 5266202, Israel
| | - Ronen Ghinea
- Sackler Medical School, Tel-Aviv University, Tel Aviv 6997801, Israel; (E.N.); (R.A.); (R.G.); (T.H.); (E.M.)
- Transplant Center, Department of Surgery B, Sheba Medical Center, Ramat Gan 5266202, Israel
| | - Tammy Hod
- Sackler Medical School, Tel-Aviv University, Tel Aviv 6997801, Israel; (E.N.); (R.A.); (R.G.); (T.H.); (E.M.)
- Transplant Center, Department of Nephrology, Sheba Medical Center, Ramat Gan 5266202, Israel
| | - Eytan Mor
- Sackler Medical School, Tel-Aviv University, Tel Aviv 6997801, Israel; (E.N.); (R.A.); (R.G.); (T.H.); (E.M.)
- Transplant Center, Department of Surgery B, Sheba Medical Center, Ramat Gan 5266202, Israel
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Scheuermann U, Babel J, Pietsch UC, Weimann A, Lyros O, Semmling K, Hau HM, Seehofer D, Rademacher S, Sucher R. Recipient obesity as a risk factor in kidney transplantation. BMC Nephrol 2022; 23:37. [PMID: 35042452 PMCID: PMC8767742 DOI: 10.1186/s12882-022-02668-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/11/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The aim of the study was to investigate the effect of recipient obesity on the short- and long-term outcomes of patients undergoing primary kidney transplantation (KT). PATIENTS AND METHODS A total of 578 patients receiving primary KT in our department between 1993 and 2017 were included in the study. Patients were divided according to their body mass index (BMI) into normal weight (BMI 18.5-24.9 kg/m2; N = 304), overweight (BMI 25-29.9 kg/m2; N = 205) and obese (BMI ≥ 30 kg/m2; N = 69) groups. Their clinicopathological characteristics, outcomes, and survival rates were analyzed retrospectively. RESULTS Obesity was associated with an increased rate of surgical complications such as wound infection (P < 0.001), fascial dehiscence (P = 0.023), and lymphoceles (P = 0.010). Furthermore, the hospital stay duration was significantly longer in the groups with obese patients compared to normal weight and overweight patients (normal weight: 22 days, overweight: 25 days, and obese: 33 days, respectively; P < 0.001). Multivariate analysis showed that recipient obesity (BMI ≥ 30) was an independent prognostic factor for delayed graft function (DGF) (OR 2.400; 95% CI, 1.365-4.219; P = 0.002) and postoperative surgical complications (OR 2.514; 95% CI, 1.230-5.136; P = 0.011). The mean death-censored graft survival was significantly lower in obese patients (normal weight: 16.3 ± 0.6 years, overweight: 16.3 ± 0.8 years, obese 10.8 ± 1.5 years, respectively; P = 0.001). However, when using the Cox proportional hazards model, the association between recipient obesity and death-censored renal graft failure disappeared, after adjustment for important covariates, whereas the principal independent predictors of graft loss were recipient diabetes mellitus and hypertension and kidneys from donors with expanded donor criteria. CONCLUSION In conclusion, obesity increases the risk of DGF and post-operative surgical complications after primary KT. Appropriate risk-adapted information concerning this must be provided to such patients before KT. Furthermore, obesity-typical concomitant diseases seem to negatively influence graft survival and need to be considered after the transplantation of obese patients.
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Affiliation(s)
- Uwe Scheuermann
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
| | - Jonas Babel
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Uta-Carolin Pietsch
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Antje Weimann
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Orestis Lyros
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Katrin Semmling
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
- Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany
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Yin S, Wu L, Huang Z, Fan Y, Lin T, Song T. Nonlinear relationship between body mass index and clinical outcomes after kidney transplantation: A dose-response meta-analysis of 50 observational studies. Surgery 2021; 171:1396-1405. [PMID: 34838329 DOI: 10.1016/j.surg.2021.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Exact dose-response relationship between body mass index at transplantation and clinical outcomes after kidney transplantation remained unclear, and no specific body mass index threshold and pretransplant weight loss aim were recommended for kidney transplantation candidates among transplant centers. METHODS PubMed, Embase, Web of Science, and Cochrane Library were searched for literature published up to December 31, 2019. The two-stage, random effect meta-analysis was performed to estimate the dose-response relationship between body mass index and clinical outcomes after kidney transplantation. RESULTS Ninety-four studies were included for qualitative assessment and 50 for dose-response meta-analyses. There was a U-shaped relationship between graft loss, patient death, and body mass index. Body mass index with the lowest risk of graft loss was 25.2 kg/m2, and preferred body mass index range was 22-28 kg/m2. Referring to a body mass index of 22 kg/m2, the risk of graft loss was 1.088, 0.981, 1.003, and 1.685 for a body mass index of 18, 24, 28, and 40 kg/m2, respectively. Body mass index with the lowest risk of patient death was 24.7 kg/m2, and preferred body mass index range was 22-27 kg/m2. Referring to a body mass index of 22 kg/m2, the patient death risk was 1.115, 0.981, 1.032, and 2.634 for a body mass index of 18, 24, 28, and 40 kg/m2, respectively. J-shaped relationships were observed between body mass index and acute rejection, delayed graft function, primary graft nonfunction, and de novo diabetes. Pair-wise comparisons showed that higher body mass index was also a risk factor for cardiovascular diseases, hypertension, infection, longer length of hospital stay, and lower estimated glomerular filtration rate level. CONCLUSION Underweight and severe obesity at transplantation are associated with a significantly increased risk of graft loss and patient death. A target body mass index at kidney transplantation is 22-27 kg/m2.
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Affiliation(s)
- Saifu Yin
- Urology Department, Urology Research Institute, Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Linyan Wu
- Department of Intensive Care Unit, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Zhongli Huang
- Urology Department, Urology Research Institute, Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Yu Fan
- Urology Department, Urology Research Institute, Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Tao Lin
- Urology Department, Urology Research Institute, Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China
| | - Turun Song
- Urology Department, Urology Research Institute, Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu City, Sichuan Province, China.
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Vranic G, Cooper M. But Why Weight: Understanding the Implications of Obesity in Kidney Transplant. Semin Nephrol 2021; 41:380-391. [PMID: 34715967 DOI: 10.1016/j.semnephrol.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Obesity is increasing in prevalence among candidates for kidney transplant. Understanding the influence of obesity on candidate evaluation, surgical risk, peritransplant management, and post-transplant outcomes is critical to ensuring equitable access to transplant for this growing population.
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Affiliation(s)
- Gayle Vranic
- MedStar Georgetown Transplant Institute, Georgetown University, Washington, DC.
| | - Matthew Cooper
- MedStar Georgetown Transplant Institute, Georgetown University, Washington, DC
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10
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Hajjar R, Marcotte C, Chan G. Conservative Management of Obesity in Kidney Transplant Candidates. J Ren Nutr 2021; 32:347-353. [PMID: 33941439 DOI: 10.1053/j.jrn.2021.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/11/2021] [Accepted: 03/14/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Obesity is prevalent in patients with chronic kidney disease and is associated with increased complications after kidney transplantation (KT). A body mass index limit is used in most transplant programs, though few studies have focused on conservative weight loss in KT candidates. The objective of this retrospective study is to evaluate the efficacy of a basic conservative weight management program in morbidly obese KT candidates and to perform a comprehensive nutritional evaluation. METHODS This retrospective study included patients with a body mass index (BMI) >35 kg/m2, with grade IV or V chronic kidney disease. The conservative weight loss program consisted of anthropometric measurements every 3 months, consultation with a nutritionist, daily exercise, and counseling for healthier eating habits. Overall and quarterly BMI targets were defined. A subset of patients further underwent a comprehensive nutritional evaluation to measure socioeconomic characteristics, food intake behavior, motivation for change, and a 4-day food diary. RESULTS Eighty patients were observed for a mean of 24 months. Successful weight loss (BMI < 35 kg/m2) was achieved in 26.3%, associated with women and those already close to the limit. The mean 1-year excess body weight loss was 8.4%. No patient with a BMI >40 kg/m2 was successful. The comprehensive nutritional evaluation was performed with 44 patients and found that only 14.6% had previously received nutritional counseling for weight loss. Cognitive restraint scored highest in the food-intake behavior. Most patients were motivated to lose weight with 66% in the action phase. There was little evidence of overeating with a recommended mean calculated daily caloric intake of 82.9%. CONCLUSION The conservative weight loss program can have limited but non-negligible, success. Future successful nutritional interventions should take into consideration this surprising comprehensive profile of morbidly obese KT candidates.
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Affiliation(s)
- Roy Hajjar
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada; Division of General Surgery, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Cynthia Marcotte
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Gabriel Chan
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada; Division of General Surgery, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
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11
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Sureshkumar KK, Chopra B, Josephson MA, Shah PB, McGill RL. Recipient Obesity and Kidney Transplant Outcomes: A Mate-Kidney Analysis. Am J Kidney Dis 2021; 78:501-510.e1. [PMID: 33872689 DOI: 10.1053/j.ajkd.2021.02.332] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/04/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE The impact of extreme recipient obesity on long-term kidney transplant outcomes has been controversial. This study sought to evaluate the association of various levels of recipient obesity on kidney transplantation outcomes by comparing mate-kidney recipient pairs to address possible confounding effects of donor characteristics on posttransplant outcomes. STUDY DESIGN Nationwide observational cohort study using mate-kidney models. SETTING & PARTICIPANTS In analysis based on the Organ Procurement and Transplant Network/United Network of Organ Sharing database, 44,560 adult recipients of first-time deceased-donor kidney transplants from 2001 through 2016 were paired by donor. PREDICTORS Recipient body mass index (BMI) categorized as 18-25 (n = 12,446), >25-30 (n = 15,477), >30-35 (n = 11,144; obese), and >35 (n = 5,493; extreme obesity) kg/m2. OUTCOMES Outcomes included patient survival, graft survival, death-censored graft survival, delayed graft function (DGF), and hospital length of stay. ANALYTICAL APPROACH Conditional logistic regression and stratified proportional hazards models were used to compare outcomes as odds ratios and hazard ratios (HRs), adjusted for recipient and transplant factors, using recipients with a BMI >35 kg/m2 as a reference. RESULTS At a median follow-up of 3.9 years, adjusted odds ratios for DGF were 0.42 (95% CI, 0.36-0.48), 0.55 (95% CI, 0.48-0.62), and 0.73 (95% CI, 0.64-0.83) for BMI 18-25, >25-30, and >30-35 kg/m2, respectively (P < 0.001 for all). Death-censored graft failure was less frequent for BMI ≤25 and >25-30 kg/m2 (HRs of 0.66 [95% CI, 0.59-0.74] and 0.79 [95% CI, 0.70-0.88], respectively; P < 0.001 for both), but not for BMI >30-35 kg/m2 (HR, 0.91 [95% CI, 0.81-1.02]; P = 0.09). Length of stay and patient survival did not differ by recipient BMI. LIMITATIONS Observational study with limited detail regarding potential confounders. CONCLUSIONS Despite an increased risk of DGF likely unrelated to donor organ quality, long-term transplant outcomes among recipients with a BMI >35 kg/m2 are similar to those among recipients with a BMI >30-35 kg/m2, supporting a flexible approach to kidney transplantation candidacy in candidates with extreme obesity.
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Affiliation(s)
- Kalathil K Sureshkumar
- Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Bhavna Chopra
- Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA
| | - Michelle A Josephson
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL
| | - Pratik B Shah
- Division of Nephrology, University of California, Davis, Sacramento, CA
| | - Rita L McGill
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL.
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12
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García-Carro C, Vergara A, Bermejo S, Azancot MA, Sellarés J, Soler MJ. A Nephrologist Perspective on Obesity: From Kidney Injury to Clinical Management. Front Med (Lausanne) 2021; 8:655871. [PMID: 33928108 PMCID: PMC8076523 DOI: 10.3389/fmed.2021.655871] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Obesity is one of the epidemics of our era. Its prevalence is higher than 30% in the U.S. and it is estimated to increase by 50% in 2030. Obesity is associated with a higher risk of all-cause mortality and it is known to be a cause of chronic kidney disease (CKD). Typically, obesity-related glomerulopathy (ORG) is ascribed to renal hemodynamic changes that lead to hyperfiltration, albuminuria and, finally, impairment in glomerular filtration rate due to glomerulosclerosis. Though not only hemodynamics are responsible for ORG: adipokines could cause local effects on mesangial and tubular cells and podocytes promoting maladaptive responses to hyperfiltration. Furthermore, hypertension and type 2 diabetes mellitus, two conditions generally associated with obesity, are both amplifiers of obesity injury in the renal parenchyma, as well as complications of overweight. As in the native kidney, obesity is also related to worse outcomes in kidney transplantation. Despite its impact in CKD and cardiovascular morbility and mortality, therapeutic strategies to fight against obesity-related CKD were limited for decades to renin-angiotensin blockade and bariatric surgery for patients who accomplished very restrictive criteria. Last years, different drugs have been approved or are under study for the treatment of obesity. Glucagon-like peptide-1 receptor agonists are promising in obesity-related CKD since they have shown benefits in terms of losing weight in obese patients, as well as preventing the onset of macroalbuminuria and slowing the decline of eGFR in type 2 diabetes. These new families of glucose-lowering drugs are a new frontier to be crossed by nephrologists to stop obesity-related CKD progression.
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Affiliation(s)
- Clara García-Carro
- Nephrology Department, San Carlos Clinical University Hospital, Madrid, Spain
| | - Ander Vergara
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Nephrology Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Sheila Bermejo
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Nephrology Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - María A. Azancot
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Nephrology Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Joana Sellarés
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Nephrology Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Maria José Soler
- Nephrology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Nephrology Group, Vall d'Hebron Research Institute, Barcelona, Spain
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13
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Spaggiari M, Di Cocco P, Tulla K, Kaylan KB, Masrur MA, Hassan C, Alvarez JA, Benedetti E, Tzvetanov I. Simultaneous robotic kidney transplantation and bariatric surgery for morbidly obese patients with end-stage renal failure. Am J Transplant 2021; 21:1525-1534. [PMID: 32976702 DOI: 10.1111/ajt.16322] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/25/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023]
Abstract
Patients with obesity have limited access to kidney transplantation, mainly due to an increased incidence of surgical complications, which could be reduced with selective use of robotic-assisted surgery. This prospective randomized controlled trial compares the safety and efficacy of combining robotic sleeve gastrectomy and robotic-assisted kidney transplant to robotic kidney transplant alone in candidates with class II or III obesity. Twenty candidates were recruited, 11 were randomized to the robotic sleeve gastrectomy and robotic-assisted kidney transplant group and 9 to the robotic kidney transplant group. At 12-month follow-up, change in body mass index was -8.76 ± 1.82 in the robotic sleeve gastrectomy and robotic-assisted kidney transplant group compared to 1.70 ± 2.30 in the robotic kidney transplant group (P = .0041). Estimated glomerular filtration rate, serum creatinine, readmission rates, and graft failure rates up to 12 months were not different between the two groups. Length of surgery was longer in the robotic sleeve gastrectomy and robotic-assisted kidney transplant group (405 minutes vs. 269 minutes, p = .00304) without increase in estimated blood loss (120 ml vs. 117 ml, p = .908) or incidence of surgical complications. Combined robotic-assisted kidney transplant and sleeve gastrectomy is safe and effective compared to robotic-assisted kidney transplant alone.
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Affiliation(s)
- Mario Spaggiari
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Pierpaolo Di Cocco
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Kiara Tulla
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Kerim B Kaylan
- College of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Mario A Masrur
- Division of General, Minimally Invasive, & Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Chandra Hassan
- Division of General, Minimally Invasive, & Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Jorge A Alvarez
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Ivo Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
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14
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Effects of Obesity on Postoperative Complications and Graft Survival After Kidney Transplantation. Transplant Proc 2020; 52:3153-3159. [DOI: 10.1016/j.transproceed.2020.02.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
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15
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Is recipient's body mass index a determinant of short term complications in early renal transplantation? Prog Urol 2020; 30:663-674. [DOI: 10.1016/j.purol.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 06/26/2020] [Accepted: 07/03/2020] [Indexed: 11/18/2022]
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16
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Yemini R, Nesher E, Carmeli I, Winkler J, Rahamimov R, Mor E, Keidar A. Bariatric Surgery Is Efficacious and Improves Access to Transplantation for Morbidly Obese Renal Transplant Candidates. Obes Surg 2020; 29:2373-2380. [PMID: 31134476 DOI: 10.1007/s11695-019-03925-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The surgical risk of morbidly obese patients is high and even higher for kidney transplant candidates. A BMI > 35-40 kg/m2 is often a contraindication for that surgery. The safety, feasibility, and outcome of bariatric surgery for those patients are inconclusive. METHODS We conducted a retrospective chart review of prospectively collected data on morbidly obese renal transplant candidates who underwent laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) in our institution between January 2009 and September 2017. The reported outcome included body weight and graft status after a mean follow-up of 47 months (range 0.5-5 years). RESULTS Twenty-four patients (8 females, 16 males, average age 54 years, average preoperative BMI 41 kg/m2 [range 35-51]) underwent LSG (n = 17) or LRYGB (n = 7). Sixteen of them (67%) proceeded to kidney transplantation. Of the 8 pre-transplant and post-bariatric surgery patients, 5 are on the waitlist, and 2 patients died (one of staple line leakage, and one from sepsis unrelated to the bariatric surgery). The average time from bariatric surgery to transplantation was 1.5 years (range 1 month to 4.3 years). The average pre-transplantation BMI was 28 kg/m2 (range 19-36). The mean percentage of excess weight loss was 66% (n = 21), and the total percentage of weight loss was 29% (n = 21). Comorbidities (type 2 diabetes, hypertension, and dyslipidemia) improved significantly following both surgical approaches. CONCLUSIONS LSG and LRYGB appear to effectively address obesity issues before kidney transplantation and improve surgical access. Morbidly obese transplant candidates would benefit from prior bariatric surgery.
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Affiliation(s)
- Renana Yemini
- Department of Surgery, Assuta Ashdod Medical Center, Ashdod, Israel. .,Ben-Gurion University, Beer-Sheva, Israel.
| | - Eviatar Nesher
- Departments of Transplant Surgery, Beilinson Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Idan Carmeli
- Department of Surgery, Assuta Ashdod Medical Center, Ashdod, Israel.,Ben-Gurion University, Beer-Sheva, Israel
| | - Janos Winkler
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Departments of Nephrology, Beilinson Medical Center, Petach-Tikva, Israel
| | - Ruth Rahamimov
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Departments of Nephrology, Beilinson Medical Center, Petach-Tikva, Israel
| | - Eytan Mor
- Departments of Transplant Surgery, Beilinson Medical Center, Petach-Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Andrei Keidar
- Department of Surgery, Assuta Ashdod Medical Center, Ashdod, Israel.,Ben-Gurion University, Beer-Sheva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Bariatric Clinic, Department of Surgery, Beilinson Medical Center, Petach-Tikva, Israel
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17
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Mehrabi A, Kulu Y, Sabagh M, Khajeh E, Mohammadi S, Ghamarnejad O, Golriz M, Morath C, Bechstein WO, Berlakovich GA, Demartines N, Duran M, Fischer L, Gürke L, Klempnauer J, Königsrainer A, Lang H, Neumann UP, Pascher A, Paul A, Pisarski P, Pratschke J, Schneeberger S, Settmacher U, Viebahn R, Wirth M, Wullich B, Zeier M, Büchler MW. Consensus on definition and severity grading of lymphatic complications after kidney transplantation. Br J Surg 2020; 107:801-811. [PMID: 32227483 DOI: 10.1002/bjs.11587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/23/2020] [Accepted: 02/14/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The incidence of lymphatic complications after kidney transplantation varies considerably in the literature. This is partly because a universally accepted definition has not been established. This study aimed to propose an acceptable definition and severity grading system for lymphatic complications based on their management strategy. METHODS Relevant literature published in MEDLINE and Web of Science was searched systematically. A consensus for definition and a severity grading was then sought between 20 high-volume transplant centres. RESULTS Lymphorrhoea/lymphocele was defined in 32 of 87 included studies. Sixty-three articles explained how lymphatic complications were managed, but none graded their severity. The proposed definition of lymphorrhoea was leakage of more than 50 ml fluid (not urine, blood or pus) per day from the drain, or the drain site after removal of the drain, for more than 1 week after kidney transplantation. The proposed definition of lymphocele was a fluid collection of any size near to the transplanted kidney, after urinoma, haematoma and abscess have been excluded. Grade A lymphatic complications have a minor and/or non-invasive impact on the clinical management of the patient; grade B complications require non-surgical intervention; and grade C complications require invasive surgical intervention. CONCLUSION A clear definition and severity grading for lymphatic complications after kidney transplantation was agreed. The proposed definitions should allow better comparisons between studies.
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Affiliation(s)
- A Mehrabi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Y Kulu
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Sabagh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - E Khajeh
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - S Mohammadi
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - O Ghamarnejad
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - M Golriz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - C Morath
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - W O Bechstein
- Department of General and Visceral Surgery, Frankfurt University Hospital, Goethe University, Frankfurt am Main, Germany
| | - G A Berlakovich
- Division of Transplantation, Department of Surgery, Vienna Medical University, Vienna, Austria
| | - N Demartines
- Department of Visceral Surgery, CHUV University Hospital, Lausanne, Switzerland
| | - M Duran
- Department of Vascular and Endovascular Surgery, Düsseldorf University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - L Fischer
- Department of Visceral and Transplantation Surgery, Hamburg-Eppendorf University Hospital, Hamburg, Germany
| | - L Gürke
- Department of Vascular and Transplantation Surgery, Basel University Hospital, Basel, Switzerland
| | - J Klempnauer
- Department of General, Visceral, and Transplantation Surgery, Hannover Medical University, Hannover, Germany
| | - A Königsrainer
- Department of General, Visceral and Transplantation Surgery, Eberhard-Karls-University Hospital, Tübingen, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg Medical University, Mainz, Germany
| | - U P Neumann
- Department of General, Visceral and Transplantation Surgery, RWTH University Hospital, Aachen, Germany
| | - A Pascher
- Department of General, Visceral and Transplantation Surgery, Münster University Hospital, Münster, Germany
| | - A Paul
- Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany
| | - P Pisarski
- Department of General, Visceral and Surgery, Freiburg University Hospital, Freiburg, Germany
| | - J Pratschke
- Department of Surgery, Charité University Hospital, Berlin, Germany
| | - S Schneeberger
- Department of Visceral, Transplantation and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - U Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - R Viebahn
- Department of Surgery, Knappschaftskrankenhaus University Hospital of Bochum, Ruhr University of Bochum, Bochum, Germany
| | - M Wirth
- Department of Urology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - B Wullich
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Erlangen, Germany
| | - M Zeier
- Division of Nephrology, Heidelberg University Hospital, Heidelberg, Germany
| | - M W Büchler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
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18
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Tzvetanov IG, Spaggiari M, Tulla KA, Di Bella C, Okoye O, Di Cocco P, Jeon H, Oberholzer J, Cristoforo Giulianotti P, Benedetti E. Robotic kidney transplantation in the obese patient: 10-year experience from a single center. Am J Transplant 2020; 20:430-440. [PMID: 31571369 DOI: 10.1111/ajt.15626] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 01/25/2023]
Abstract
Despite increasing obesity rates in the dialysis population, obese kidney transplant candidates are still denied transplantation by many centers. We performed a single-center retrospective analysis of a robotic-assisted kidney transplant (RAKT) cohort from January 2009 to December 2018. A total of 239 patients were included in this analysis. The median BMI was 41.4 kg/m2 , with the majority (53.1%) of patients being African American and 69.4% of organs sourced from living donors. The median surgery duration and warm ischemia times were 4.8 hours and 45 minutes respectively. Wound complications (mostly seromas and hematomas) occurred in 3.8% of patients, with 1 patient developing a surgical site infection (SSI). Seventeen (7.1%) graft failures, mostly due to acute rejection, were reported during follow-up. Patient survival was 98% and 95%, whereas graft survival was 98% and 93%, at 1 and 3 years respectively. Similar survival statistics were obtained from patients undergoing open transplant over the same time period from the UNOS database. In conclusion, RAKT can be safely performed in obese patients with minimal SSI risk, excellent graft function, and patient outcomes comparable to national data. RAKT could improve access to kidney transplantation in obese patients due to the low surgical complication rate.
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Affiliation(s)
- Ivo G Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Mario Spaggiari
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Kiara A Tulla
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Caterina Di Bella
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Obi Okoye
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Pierpaolo Di Cocco
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Hoonbae Jeon
- Department of Surgery, Tulane University, New Orleans, Louisiana
| | - Jose Oberholzer
- Charles O. Strickler Transplant Center, University of Virginia Health System, Charlottesville, Virginia
| | - Pier Cristoforo Giulianotti
- Division of General, Minimally Invasive, & Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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19
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Beaudreuil S, Iglicki F, Ledoux S, Elias M, Obada ENN, Hebibi H, Durand E, Charpentier B, Coffin B, Durrbach A. Efficacy and Safety of Intra-gastric Balloon Placement in Dialyzed Patients Awaiting Kidney Transplantation. Obes Surg 2019; 29:713-720. [PMID: 30474792 DOI: 10.1007/s11695-018-3574-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The number of obese patients who are candidates for renal transplantation has considerably increased, but obesity can be a barrier to kidney transplantation. Weight loss is often difficult through diet alone. We studied the efficacy and tolerance of the intra-gastric balloon (IGB) procedure in obese patients who were undergoing dialysis and were candidates for a renal transplantation. PATIENTS AND METHODS Obese patients (BMI > 30 kg/m2) who were candidates for renal transplantation were prospectively included in the study between 2010 and 2012. The balloon was inserted and removed during a gastric endoscopy under general anesthesia. The treatment lasted 6 months. The end point was a decrease in BMI after 6 months. Body impedance spectrometry (BIS) and nutritional statute were evaluated initially and then after IGB removal. RESULTS Seventeen patients (nine females and eight males) with a mean age of 53.4 years [19.4-69.4] were included. The decrease in body mass index (BMI) during the 6-month placement was 3 kg/m2 (from 37.7 to 34.4 kg/m2). The mean weight loss was 7 kg. The mean percentage of excess weight loss after 6 months was 20.2 (± 11.4). The tolerance was good without any complications. Eleven patients underwent kidney transplantation. CONCLUSION IGB in obese dialyzed patients who are candidates for renal transplantation is safe and effective. However, the amount of weight loss can vary.
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Affiliation(s)
- Séverine Beaudreuil
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France. .,INSERM UMRS1197, Villejuif, France.
| | - Franck Iglicki
- Gastroenterology Unit, AP-HP, Louis Mourier Hospital and Denis Diderot University Paris 7, Paris, France
| | - Séverine Ledoux
- Service des Explorations Fonctionnelles and Centre Intégré Nord Francilien de prise en charge de l'Obésité (CINFO), Hôpital Louis Mourier (AP-HP) and Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Michelle Elias
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France
| | - Erika NNang Obada
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France
| | - Hadia Hebibi
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France
| | - Emmanuel Durand
- IR4M (UMR8081), 91405 Univ Paris Sud, Univ Paris Saclay, Department of Nuclear Medicine, Hôpitaux Universitaires Paris Sud, Paris, France
| | - Bernard Charpentier
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France.,INSERM UMRS1197, Villejuif, France
| | - Benoit Coffin
- Gastroenterology Unit, AP-HP, Louis Mourier Hospital and Denis Diderot University Paris 7, Paris, France
| | - Antoine Durrbach
- Department of Nephrology Dialysis, Transplantation, IFRNT, University of Paris-Sud, Le Kremlin Bicetre, France.,INSERM UMRS1197, Villejuif, France
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20
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Di Cocco P, Okoye O, Almario J, Benedetti E, Tzvetanov IG, Spaggiari M. Obesity in kidney transplantation. Transpl Int 2019; 33:581-589. [PMID: 31667905 DOI: 10.1111/tri.13547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/03/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022]
Abstract
The prevalence of obesity among patients with chronic kidney disease continues to increase as a reflection of the trend observed in the general population. Factors affecting the access to the waiting list and the transplantability of this specific population will be analysed. From observational studies, kidney transplantation in obese patients carries an increased risk of surgical complications compared to the nonobese population; therefore, many centres have been reluctant to proceed with transplantation, despite this treatment modality confers a survival advantage over dialysis. As a consequence, obese patients continue to face decreased access to the waiting list, with a lower likelihood of being transplanted and higher waiting times when compared to the nonobese candidates. In this review will be described the current strategies for treatment of obesity in different settings (pretransplant, at transplant and post-transplant). Obesity represents a risk factor for surgical complications but not a contraindication for kidney transplantation; outcomes could be greatly improved with its multidisciplinary and multimodal treatment. The modern technology with minimally invasive techniques, mainly using robotic platform, allows a reduction in the surgical complications rate, with graft and patient survival rates comparable to the nonobese counterpart.
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Affiliation(s)
- Pierpaolo Di Cocco
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Obi Okoye
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Jorge Almario
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Ivo G Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Mario Spaggiari
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA
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Kim Y, Bailey AJ, Morris MC, Kassam AF, Shah SA, Diwan TS. Kidney transplantation after sleeve gastrectomy in the morbidly obese candidate: results of a 2-year experience. Surg Obes Relat Dis 2019; 16:10-14. [PMID: 31668565 DOI: 10.1016/j.soard.2019.09.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/24/2019] [Accepted: 09/13/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Morbid obesity serves as a barrier to kidney transplantation (KT) due to potential suboptimal posttransplant outcomes. Laparoscopic sleeve gastrectomy (LSG) has previously been shown to improve transplant eligibility through weight loss. OBJECTIVES We aimed to examine the role LSG plays in improving patient outcomes postrenal transplantation, including possible impact on new-onset diabetes after transplant (NODAT). SETTING University Hospital. METHODS A single-center analysis was performed identifying all patients who underwent KT after LSG from 2011 to 2017 (n = 41). Exclusion criteria included type I diabetes and previous pancreas transplantation. NODAT was defined as a new insulin requirement after KT. Delayed graft function was defined as need for dialysis within the first week after KT. Mean posttransplant follow-up period was 22 months. RESULTS Forty-one patients underwent KT after LSG after median time of 16 months. Median age of postLSG patients undergoing KT was 56.0 years at time of KT. Average body mass index decreased by 9 from the time of LSG to KT, and no patients regained weight at 1-year follow-up. After LSG, the number of patients with hypertension (85.4% versus 48.5%) and the number of antihypertensive medications used decreased significantly (1.6 versus .6) at time of KT (P < .001 each). At 1-year follow-up, the improvement in hypertension persisted (51.2% versus 48.5%, P = nonsignificant). The average insulin regimen decreased from 33.0 ± 51.6 to 11.7 ± 21.5 units at KT (P < .001). This improvement also persisted at 1-year follow-up (11.9 versus 11.7 units, P = nonsignificant). Zero patients suffered NODAT over the follow-up period (versus institutional rate of NODAT at 15.8%). One patient developed delayed graft function (2.4%, versus institutional rate of 13.3%). After 1 year postKT, there was 1 graft loss (2.4%) and no mortality. CONCLUSION This is the largest reported series of KT after planned LSG in morbidly obese patients. Our results confirm excellent posttransplant outcomes among patients who otherwise would have been denied KT eligibility.
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Affiliation(s)
- Young Kim
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amanda J Bailey
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mackenzie C Morris
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Al-Faraaz Kassam
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shimul A Shah
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Tayyab S Diwan
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
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Ertugrul G. Retrospective analysis of patients with kidney transplantation. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2019. [DOI: 10.32322/jhsm.530669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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23
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The Evolution of Kidney Transplantation Surgery Into the Robotic Era and Its Prospects for Obese Recipients. Transplantation 2019; 102:1650-1665. [PMID: 29916987 DOI: 10.1097/tp.0000000000002328] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Robotic-assisted kidney transplantation (RAKT) represents the most recent innovation in the evolution of kidney transplantation surgery. Vascular techniques enabling kidney transplantation have existed since the early 20th century and contributed to the first successful open kidney transplant procedure in 1954. Technical advances have since facilitated minimally invasive laparoscopic and robotic techniques in live-donor surgery, and subsequently for the recipient procedure. This review follows the development of surgical techniques for kidney transplantation, with a special focus on the advent of robotic-assisted transplantation because of its potential to facilitate transplantation of those deemed previously too obese to transplant by standard means. The different techniques, indications, advantages, disadvantages, and future directions of this approach will be explored in detail. Robot-assisted kidney transplantation may become the preferred means of transplanting morbidly obese recipients, although its availability to such recipients remains extremely limited and strategies targeting weight loss pretransplantation should never be abandoned in favor of a "RAKT-first" approach.
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Schindel H, Winkler J, Yemini R, Carmeli I, Nesher E, Keidar A. Survival benefit in bariatric surgery kidney recipients may be mediated through effects on kidney graft function and improvement of co-morbidities: A case-control study. Surg Obes Relat Dis 2019; 15:621-627. [PMID: 30827810 DOI: 10.1016/j.soard.2019.01.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 01/11/2019] [Accepted: 01/31/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Data on the benefits of bariatric surgery for morbid obesity among kidney transplant recipients are scarce. OBJECTIVE To examine the effect of bariatric surgery on graft function and survival and on obesity-related co-morbidities. SETTING University hospital. METHODS This case-control study used retrospectively collected data of all kidney recipients who underwent bariatric surgery in our institution between November 2011 and August 2016 (n = 30, 11 females). Nonbariatric operated kidney recipients matched for age, sex, and time elapsed since transplantation served as controls (n = 50, 23 females). Main outcomes were renal function, graft loss events, mortality, and obesity-related co-morbidities. RESULTS The mean follow-up duration was 2.4 ± 1.3 years for both groups. At final follow-up, there was an increase in estimated glomerular filtration rates for the bariatric surgery group, and a decrease for the controls (13.4 ± 19.9 and -3.9 ± 15.8 mL/min/1.73 m2, respectively, P < .001). The chronic kidney disease classification improved in 9 bariatric surgery group patients and in 6 controls (P = .1). Two patients in the bariatric surgery group and 6 controls died. Total death or graft function loss during the follow-up was 6.7% and 16.7%, respectively (P = .3). The total numbers of co-morbidities and medications were lower in the bariatric surgery patients (-.7 and -2, respectively) and higher in the controls (+.3 and +1.1; P < .001) at study closure. CONCLUSIONS There was an improvement in renal function, graft survival, and obesity-related co-morbidities among kidney transplant recipients who underwent bariatric surgery compared with those who did not. These findings support bariatric surgery in this population and warrant prospective studies.
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Affiliation(s)
- Hilla Schindel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Janos Winkler
- Department of Nephrology, Rabin Medical Center, Petach Tiqva, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Renana Yemini
- Department of Surgery - Bariatric Clinic, Rabin Medical Center, Petach Tiqva, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Idan Carmeli
- Department of Surgery - Bariatric Clinic, Rabin Medical Center, Petach Tiqva, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Eviatar Nesher
- Department of Transplantation, Rabin Medical Center, Petach Tiqva, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Andrei Keidar
- Department of Surgery - Bariatric Clinic, Rabin Medical Center, Petach Tiqva, Israel, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Abstract
Obesity, which has become an increasing problem worldwide, poses a risk for kidney transplant recipients both before and after surgery. In this literature review, we studied the effects of obesity before and after kidney transplant. There are numerous studies and different opinions on the effects of obesity on graft function before and after transplant. Obesity prolongs surgery time and the ischemic process. A large cohort study of 11 836 recipients noted a close association between body mass index and delayed renal transplant and delayed graft function. However, another study found that being overweight or obese before transplant did not have any effects over the medium and long term. A 20-year follow-up study indicated that the firstyear body mass index in recipients after renal transplant had a greater effect on graft function and survival than body mass index before transplant. Still, another study found that body mass index had no effects on graft function and survival. In the study, 3-year graft function and mortality rates of morbidly obese people without diabetes, the functional status without dialysis, and living-donor transplant were reported to be much lower than in those with normal weight. In conclusion, there is no consensus on the effects of obesity before and after transplant, and it has been pointed out that more research should be done on this subject.
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Affiliation(s)
- Damla Ateş
- From the Department of Surgical Nursing, Akdeniz University, Antalya, Turkey
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Kim Y, Jung AD, Dhar VK, Tadros JS, Schauer DP, Smith EP, Hanseman DJ, Cuffy MC, Alloway RR, Shields AR, Shah SA, Woodle ES, Diwan TS. Laparoscopic sleeve gastrectomy improves renal transplant candidacy and posttransplant outcomes in morbidly obese patients. Am J Transplant 2018; 18:410-416. [PMID: 28805345 DOI: 10.1111/ajt.14463] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 01/25/2023]
Abstract
Morbid obesity is a barrier to kidney transplantation due to inferior outcomes, including higher rates of new-onset diabetes after transplantation (NODAT), delayed graft function (DGF), and graft failure. Laparoscopic sleeve gastrectomy (LSG) increases transplant eligibility by reducing BMI in kidney transplant candidates, but the effect of surgical weight loss on posttransplantation outcomes is unknown. Reviewing single-center medical records, we identified all patients who underwent LSG before kidney transplantation from 2011-2016 (n = 20). Post-LSG kidney recipients were compared with similar-BMI recipients who did not undergo LSG, using 2:1 direct matching for patient factors. McNemar's test and signed-rank test were used to compare groups. Among post-LSG patients, mean BMI ± standard deviation (SD) was 41.5 ± 4.4 kg/m2 at initial encounter, which decreased to 32.3 ± 2.9 kg/m2 prior to transplantation (P < .01). No complications, readmissions, or mortality occurred following LSG. After transplantation, one patient (5%) experienced DGF, and no patients experienced NODAT. Allograft and patient survival at 1-year posttransplantation was 100%. Compared with non-LSG patients, post-LSG recipients had lower rates of DGF (5% vs 20%) and renal dysfunction-related readmissions (10% vs 27.5%) (P < .05 each). Perioperative complications, allograft survival, and patient survival were similar between groups. These data suggest that morbidly obese patients with end-stage renal disease who undergo LSG to improve transplant candidacy, achieve excellent posttransplantation outcomes.
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Affiliation(s)
- Y Kim
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - A D Jung
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - V K Dhar
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - J S Tadros
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - D P Schauer
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - E P Smith
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - D J Hanseman
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - M C Cuffy
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - R R Alloway
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - A R Shields
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - S A Shah
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - E S Woodle
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - T S Diwan
- Cincinnati Collaborative for Obesity Research (CCORE), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
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Abstract
Background The prevalence of overweight and obese kidney transplant recipients (KTR) has risen in parallel to the obesity epidemic that has affected the general population over the last two decades. At present, there is an ongoing debate regarding the suitability for transplantation of obese patients. Methods Data were prospectively collected on consecutive single organ KTR transplanted between January 2014 and March 2016. The patients were stratified according to their body mass index (BMI) using the World Health Organization classification. As a measure of allograft function Modification of Diet in Renal Disease, estimated glomerular filtration rate was used at 3, 6, and 12 months posttransplant. Results We included 370 KTR: 126 of 370 women; median age, 52.7 years (range, 19-77 years), followed up for a median of 19.5 ± 8.6 months. In total, 155 (41.9%) KTR were underweight or of normal BMI at transplant, whereas 148 (40%) were overweight, and 67 (18.1%) were classified as obese (47 [12.7%] class 1, 11 [3%] class 2, 9 [2.4%] class 3). Overweight and obese KTR had a higher incidence of pretransplant diabetes (P = 0.021), but no difference was found in new-onset hyperglycemia posttransplant (P = 0.35). There was also no difference in posttransplant hospital length of stay (P = 0.386). Obese and overweight KTR had a significantly lower estimated glomerular filtration rate than underweight and normal BMI KTR at 3 and 6 months posttransplant, a finding that did not persist at 1 year follow-up. Overall, 23 patients lost their grafts, and 20 patients died during follow-up. Kaplan Meier analysis showed no difference in allograft loss between the different BMI groups (log rank P = 0.7). Conclusions In this single-center study, which used short-term data, overweight and obese patients were shown not to have inferior outcomes regarding renal function 1 year posttransplant.
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Thomas C, van de Plas J, Tsaur I, Neisius A, Bartsch G, Frees S, Borgmann H, Jäger W, Brandt MP, Haferkamp A, Rubenwolf P. Incidence, Risk Factors and Management of Symptomatic Lymphoceles after Radical Retropubic Prostatectomy. UROLOGY PRACTICE 2017. [DOI: 10.1016/j.urpr.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Igor Tsaur
- Department of Urology, University of Mainz, Mainz, Germany
| | | | - Georg Bartsch
- Department of Urology, University of Mainz, Mainz, Germany
| | | | | | - Wolfgang Jäger
- Department of Urology, University of Mainz, Mainz, Germany
| | | | - Axel Haferkamp
- Department of Urology, University of Mainz, Mainz, Germany
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Li C, Jin H, Xiao L, Li Z, Cai M, Shi B. Association Between Overweight and Renal Transplant Outcomes: A Meta-Analysis. EXP CLIN TRANSPLANT 2017; 15:527-531. [PMID: 28697714 DOI: 10.6002/ect.2016.0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES As the demand for kidney transplant allografts has increased, many centers are expanding the upper limit of acceptable body mass index for kidney donors. However, obesity is a risk factor for developing renal disease. Our goal was to quantify body mass index trends in donor nephrectomy patients and to institute nutrition counseling to promote sustainable weight loss to reduce the risk of metabolic syndrome-derived renal dysfunction. MATERIALS AND METHODS Ninety patients who underwent donor nephrectomy between 2007 and 2012 consented to having height and weight data collected at multiple time points. After data collection, each patient underwent a standardized nutrition counseling session. One year later, body mass index was reassessed. RESULTS Preoperatively, 52% of the patients were overweight or obese. The percentage of overweight and obese patients remained stable for 2 years after surgery. However, at 3, 4, and 5 years after surgery, these rates increased to 59%, 69%, and 91%. Each patient was counseled about obesity-related comorbidities and provided information about lifestyle modification. One year later, 94% of previously overweight patients and 82% of previously obese patients had a decrease in mean body mass index from 27.2 ± 4.0 kg/m2 to 25.1 ± 3.6 kg/m2. CONCLUSIONS Living-donor nephrectomy patients are at risk of developing obesity, similar to the adult population. Nutrition counseling may be beneficial to help normalize body mass index in patients who have become overweight or obese to potentially prevent obesity-related comorbidities. All patients were evaluated by a nutrition specialist after surgery to review our donor nephrectomy nutrition brochure. Body mass index monitoring and primary care follow-up appear to be appropriate surveillance methods.
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Affiliation(s)
- Congran Li
- From the Organ Transplant Institute of PLA, Organ Transplant Center, Beijing, Beijing, China
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Pinto H, Leal R, Rodrigues L, Santos L, Romãozinho C, Macário F, Alves R, Bastos C, Roseiro A, Costa F, Campos M, Mota A, Figueiredo A. Surgical Complications in Early Post-transplant Kidney Recipients. Transplant Proc 2017; 49:821-823. [DOI: 10.1016/j.transproceed.2017.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Sood A, Hakim DN, Hakim NS. Consequences of Recipient Obesity on Postoperative Outcomes in a Renal Transplant: A Systematic Review and Meta-Analysis. EXP CLIN TRANSPLANT 2016. [PMID: 27015529 DOI: 10.6002/ect.2015.0295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The prevalence of obesity is increasing rapidly and globally, yet systemic reviews on this topic are scarce. Our meta-analysis and systemic review aimed to assess how obesity affects 5 postoperative outcomes: biopsy-proven acute rejection, patient death, allograft loss, type 2 diabetes mellitus after transplant, and delayed graft function. MATERIALS AND METHODS We evaluated peer-reviewed literature from 22 medical databases. Studies were included if they were conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology criteria, only examined postoperative outcomes in adult patients, only examined the relation between recipient obesity at time of transplant and our 5 postoperative outcomes, and had a minimum score of > 5 stars on the Newcastle-Ottawa scale for nonrandomized studies. Reliable conclusions were ensured by having our studies examined against 2 internationally known scoring systems. Obesity was defined in accordance with the World Health Organization as having a body mass index of > 30 kg/m(2). All obese recipients were compared versus "healthy" recipients (body mass index of 18.5-24.9 kg/m(2)). Hazard ratios were calculated for biopsy-proven acute rejection, patient death, allograft loss, and type 2 diabetes mellitus after transplant. An odds ratio was calculated for delayed graft function. RESULTS We assessed 21 retrospective observational studies in our meta-analysis (N = 241 381 patients). In obese transplant recipients, hazard ratios were 1.51 (95% confidence interval, 1.24-1.78) for presence of biopsy-proven acute rejection, 1.19 (95% confidence interval, 1.10-1.31) for patient death, 1.54 (95% confidence interval, 1.38-1.68) for allograft loss, and 1.01 (95% confidence interval, 0.98-1.07) for development of type 2 diabetes mellitus. The odds ratio for delayed graft function was 1.81 (95% confidence interval, 1.51-2.13). CONCLUSIONS Our meta-analysis clearly demonstrated greater risks for obese renal transplant recipients and poorer postoperative outcomes with obesity. We confidently recommend renal transplant candidates seek medically supervised weight loss before transplant.
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Affiliation(s)
- Anshuman Sood
- From the Royal College of Surgeons in Ireland, Dublin, Ireland
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Kim Y, Chang AL, Wima K, Ertel AE, Diwan TS, Abbott DE, Shah SA. The impact of morbid obesity on resource utilization after renal transplantation. Surgery 2016; 160:1544-1550. [PMID: 27574775 DOI: 10.1016/j.surg.2016.07.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/15/2016] [Accepted: 07/27/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND A growing number of renal transplant recipients have a body mass index ≥40. While previous studies have shown that patient and graft survival are significantly decreased in renal transplant recipients with body mass indexes ≥40, less is known about perioperative outcomes and resource utilization in morbidly obese patients. We aimed to analyze the effects of morbid obesity on these parameters in renal transplant. METHODS Using a linkage between the Scientific Registry of Transplant Recipients and the databases of the University HealthSystem Consortium, we identified 29,728 adult renal transplant recipients and divided them into 2 cohorts based on body mass index (<40 vs ≥40 kg/m2). The body mass index ≥40 group comprised 2.5% (n = 747) of renal transplant recipients studied. RESULTS Body mass index ≥40 recipients incurred greater direct costs ($84,075 vs $79,580, P < .01), index admission costs ($91,169 vs $86,141, P < .01), readmission costs ($5,306 vs $4,596, P = .01), and combined costs ($99,590 vs $93,939, P < .001). Thirty-day readmission rates were also greater among body mass index ≥40 recipients (33.92% vs 26.9%, P < .01). Morbid obesity was not predictive of stay (odds ratio 1.01, P = .75). CONCLUSION Morbidly obese renal transplant recipients incur greater costs and readmission rates compared with nonobese patients. Recognition of increased resource utilization should be accompanied by appropriate, risk-adjustment reimbursement.
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Affiliation(s)
- Young Kim
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Alex L Chang
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Koffi Wima
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Audrey E Ertel
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Tayyab S Diwan
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daniel E Abbott
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Shimul A Shah
- Cincinnati Research in Outcomes and Safety in Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH.
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Wołyniec Z, Dębska-Ślizień A, Wołyniec W, Rutkowski B. Impact of Obesity on Renal Graft Function—Analysis of Kidney Grafts From the Same Donor. Transplant Proc 2016; 48:1482-8. [DOI: 10.1016/j.transproceed.2015.12.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 01/10/2023]
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Tremblay S, Kaiser TE, Alloway RR, Woodle ES, Diwan TS. Absence of the Effect of Pretransplant Body Mass Index on Post Kidney Transplant Outcomes. Prog Transplant 2016; 26:183-90. [PMID: 27207408 DOI: 10.1177/1526924816640679] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
CONTEXT 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/m(2). 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.
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Affiliation(s)
- Simon Tremblay
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Tiffany E Kaiser
- Division of Digestive Diseases, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Rita R Alloway
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - E Steve Woodle
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Tayyab S Diwan
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
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Tran MH, Foster CE, Kalantar-Zadeh K, Ichii H. Kidney transplantation in obese patients. World J Transplant 2016; 6:135-143. [PMID: 27011911 PMCID: PMC4801789 DOI: 10.5500/wjt.v6.i1.135] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/25/2015] [Accepted: 12/18/2015] [Indexed: 02/05/2023] Open
Abstract
The World Health Organization estimated that in 2014, over 600 million people met criteria for obesity. In 2011, over 30% of individuals undergoing kidney transplant had a body mass index (BMI) 35 kg/m2 or greater. A number of recent studies have confirmed the relationship between overweight/obesity and important comorbidities in kidney transplant patients. As with non-transplant surgeries, the rate of wound and soft tissue complications are increased following transplant as is the incidence of delayed graft function. These two issues appear to contribute to longer length of stay compared to normal BMI. New onset diabetes after transplant and cardiac outcomes also appear to be increased in the obese population. The impact of obesity on patient survival after kidney transplantation remains controversial, but appears to mirror the impact of extremes of BMI in non-transplant populations. Early experience with (open and laparoscopic) Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy support excellent weight loss (in the range of 50%-60% excess weight lost at 1 year), but experts have recommended the need for further studies. Long term nutrient deficiencies remain a concern but in general, these procedures do not appear to adversely impact absorption of immunosuppressive medications. In this study, we review the literature to arrive at a better understanding of the risks related to renal transplantation among individuals with obesity.
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Orlic L, Mikolasevic I, Jakopcic I, Grskovic A, Jelic Pranjic I, Racki S, Stimac D. Body mass index: short- and long-term impact on kidney transplantation. Int J Clin Pract 2015; 69:1357-65. [PMID: 26268780 DOI: 10.1111/ijcp.12715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/22/2015] [Indexed: 12/22/2022] Open
Abstract
AIM The topic of pretransplantation body mass index (BMI) is still a matter of controversy. The aim of this study was to investigate the influence of pretransplant BMI on short- and long-term outcomes in patients receiving kidney transplant. METHODS We have analysed 521 renal transplant recipients (RTRs). BMI was categorised as follows: less than or equal to 20, more than 20 to less than or equal to 25, more than 25 to less than or equal to 30 and more than 30 RESULTS: The distribution of the RTRs per category of BMI at baseline was: ≤ 20 (14.4%), > 20 to ≤ 25 (50.9%), > 25 ≤ 30 (26.9%) and > 30 (7.9%). In further analysis, the patients were stratified into four groups according to their pretransplant BMI values. There was no difference in the rates of delayed graft function between the four analysed groups of patients. Recipients with normal pre-transplant BMI were less likely to develop wound complications in comparison to the recipients with high BMI (p = 0.04) and obese recipients (p = 0.0001). RTRs with normal BMI were less likely to develop lymphoceles in comparison to the recipients with high BMI (p = 0.0003). Obese patients were more likely to develop lymphocele in comparison to the recipients with high BMI (p = 0.01). Obese recipients had a longer mean length of hospital stay in comparison to the recipients with normal BMI (p = 0.04). There was no significant difference regarding 1-year graft and patient survival, as well as because of acute rejection crisis between the investigated groups of recipients. We did not find any significant difference in 5-year patients and graft survival between those RTRs with BMI > 20 to ≤ 25 and to those recipients with BMI > 25. CONCLUSION Overweight and obese transplant candidates should not be excluded from kidney transplantation.
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Affiliation(s)
- L Orlic
- Department of Nephrology, Dialysis and Kidney Transplantation, UHC, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
| | - I Mikolasevic
- Department of Nephrology, Dialysis and Kidney Transplantation, UHC, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
- Department of Gastroenterology, UHC, Rijeka, Croatia
| | | | - A Grskovic
- School of Medicine, Rijeka, Croatia
- Department of Urology, UHC, Rijeka, Croatia
| | - I Jelic Pranjic
- Department of Nephrology, Dialysis and Kidney Transplantation, UHC, Rijeka, Croatia
| | - S Racki
- Department of Nephrology, Dialysis and Kidney Transplantation, UHC, Rijeka, Croatia
- School of Medicine, Rijeka, Croatia
| | - D Stimac
- School of Medicine, Rijeka, Croatia
- Department of Gastroenterology, UHC, Rijeka, Croatia
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Chan G, Garneau P, Hajjar R. The impact and treatment of obesity in kidney transplant candidates and recipients. Can J Kidney Health Dis 2015; 2:26. [PMID: 26236496 PMCID: PMC4522095 DOI: 10.1186/s40697-015-0059-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 06/19/2015] [Indexed: 12/21/2022] Open
Abstract
The prevalence of obesity in patients with chronic kidney failure and renal transplant candidates has paralleled the epidemic in the general population. The associated risks of surgical complications and long-term cardiovascular death are significant: most transplant centers consider obesity a relative contra-indication for transplant. Few studies have focused on conservative weight loss strategies in transplant patients. Studies using administrative databases have found that only a minority of wait-listed patients lose weight and with no apparent benefit to transplant outcomes. The only clinical trial in this area found that an intensive weight-loss program had significantly better success (to listing) than self-directed weight loss. However, only a minority that succeeded with the help of a program (36 %), while the “diet and exercise” group had negligible results. Laparoscopy has radically shortened the recovery time and decreased the complications associated with bariatric surgery. Reports in transplant patients, who were previously deemed too medically complex, have demonstrated a dramatic and rapid weight loss. The only randomized clinical trial in patients with CKD, which compared sleeve gastrectomy to best medical care clearly favoured the surgical arm for weight loss, but was too small to assess other outcomes. The emerging experience is small but quite promising. Surgical complications and the effect on immunosuppression remain the chief concerns regarding the use of bariatric surgery in transplant patients. Rigorous prospective studies will be essential to properly evaluate the expected weight loss and the effect on pharmacokinetics of immunosuppressive medications. A routine role for bariatric surgery in transplantation would require evidence of improvements in patient-important outcomes and evidence of safety.
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Affiliation(s)
- Gabriel Chan
- Département de Chirurgie, Université de Montréal and Service de Transplantation Rénale, Hôpital Maisonneuve-Rosemont, Montreal, Canada
| | - Pierre Garneau
- Département de Chirurgie, Université de Montréal, Hôpital Sacre-Cœur de Montréal, Montreal, Canada
| | - Roy Hajjar
- Département de Chirurgie, Université de Montréal and Service de Transplantation Rénale, Hôpital Maisonneuve-Rosemont, Montreal, Canada
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Hill CJ, Courtney AE, Cardwell CR, Maxwell AP, Lucarelli G, Veroux M, Furriel F, Cannon RM, Hoogeveen EK, Doshi M, McCaughan JA. Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis. Nephrol Dial Transplant 2015; 30:1403-11. [PMID: 26044837 DOI: 10.1093/ndt/gfv214] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/15/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The prevalence of obesity is increasing globally and is associated with chronic kidney disease and premature mortality. However, the impact of recipient obesity on kidney transplant outcomes remains unclear. This study aimed to investigate the association between recipient obesity and mortality, death-censored graft loss and delayed graft function (DGF) following kidney transplantation. METHODS A systematic review and meta-analysis was conducted using Medline, Embase and the Cochrane Library. Observational studies or randomized controlled trials investigating the association between recipient obesity at transplantation and mortality, death-censored graft loss and DGF were included. Obesity was defined as a body mass index (BMI) of ≥30 kg/m(2). Obese recipients were compared with those with a normal BMI (18.5-24.9 kg/m(2)). Pooled estimates of hazard ratios (HRs) for patient mortality or death-censored graft loss and odds ratios (ORs) for DGF were calculated. RESULTS Seventeen studies including 138 081 patients were analysed. After adjustment, there was no significant difference in mortality risk in obese recipients [HR = 1.24, 95% confidence interval (CI) = 0.90-1.70, studies = 5, n = 83 416]. However, obesity was associated with an increased risk of death-censored graft loss (HR = 1.06, 95% CI = 1.01-1.12, studies = 5, n = 83 416) and an increased likelihood of DGF (OR = 1.68, 95% CI = 1.39-2.03, studies = 4, n = 28 847). CONCLUSIONS Despite having a much higher likelihood of DGF, obese transplant recipients have only a slightly increased risk of graft loss and experience similar survival to recipients with normal BMI.
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Affiliation(s)
| | | | | | | | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Massimiliano Veroux
- Vascular Surgery and Organ Transplant Unit, University of Catania, Catania, Italy
| | - Frederico Furriel
- Department of Urology and Renal Transplantation, University Hospital, Coimbra, Portugal
| | - Robert M Cannon
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Ellen K Hoogeveen
- Department of Nephrology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mona Doshi
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
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Lafranca JA, IJermans JNM, Betjes MGH, Dor FJMF. Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis. BMC Med 2015; 13:111. [PMID: 25963131 PMCID: PMC4427990 DOI: 10.1186/s12916-015-0340-5] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/31/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Whether overweight or obese end stage renal disease (ESRD) patients are suitable for renal transplantation (RT) is often debated. The objective of this review and meta-analysis was to systematically investigate the outcome of low versus high BMI recipients after RT. METHODS Comprehensive searches were conducted in MEDLINE OvidSP, Web of Science, Google Scholar, Embase, and CENTRAL (the Cochrane Library 2014, issue 8). We reviewed four major guidelines that are available regarding (potential) RT recipients. The methodology was in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and written based on the PRISMA statement. The quality assessment of studies was performed by using the GRADE tool. A meta-analysis was performed using Review Manager 5.3. Random-effects models were used. RESULTS After identifying 5,526 studies addressing this topic, 56 studies were included. We extracted data for 37 outcome measures (including data of more than 209,000 RT recipients), of which 26 could be meta-analysed. The following outcome measures demonstrated significant differences in favour of low BMI (<30) recipients: mortality (RR = 1.52), delayed graft function (RR = 1.52), acute rejection (RR = 1.17), 1-, 2-, and 3-year graft survival (RR = 0.97, 0.95, and 0.97), 1-, 2-, and 3-year patient survival (RR = 0.99, 0.99, and 0.99), wound infection and dehiscence (RR = 3.13 and 4.85), NODAT (RR = 2.24), length of hospital stay (2.31 days), operation duration (0.77 hours), hypertension (RR = 1.35), and incisional hernia (RR = 2.72). However, patient survival expressed in hazard ratios was in significant favour of high BMI recipients. Differences in other outcome parameters were not significant. CONCLUSIONS Several of the pooled outcome measurements show significant benefits for 'low' BMI (<30) recipients. Therefore, we postulate that ESRD patients with a BMI >30 preferably should lose weight prior to RT. If this cannot be achieved with common measures, in morbidly obese RT candidates, bariatric surgery could be considered.
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Affiliation(s)
- Jeffrey A Lafranca
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Jan N M IJermans
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Michiel G H Betjes
- Department of Nephrology, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Frank J M F Dor
- Department of Surgery, division of HPB & Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, 's Gravendijkwal 230, PO BOX 2040, 3000, CA, Rotterdam, The Netherlands.
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Giuliani S, Gamba P, Kiblawi R, Midrio P, Ghirardo G, Zanon GF. Lymphocele after pediatric kidney transplantation: incidence and risk factors. Pediatr Transplant 2014; 18:720-5. [PMID: 25163815 DOI: 10.1111/petr.12341] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2014] [Indexed: 11/30/2022]
Abstract
Lymphocele is a well-known postoperative complication after kidney transplantation. The aim of this study was to analyze time trend incidence, risk factors, and outcome of post-transplant lymphocele in a large pediatric cohort. This is a retrospective single institution review of 241 pediatric kidney transplants performed from 2000 to 2013. Etiology of end-stage renal disease, recipient age and gender, transplant year, BMI percentile for age, type of dialysis, living/non-living related donor, acute rejection, and multiple transplantations were analyzed in association with lymphocele formation. Fourteen of 241 (5.81%) children developed a postoperative lymphocele. There has been a reduction in the incidence of lymphocele after 2006 (3.22% vs. 8.55%, p < 0.05). Significant risk factors for lymphocele were older age (≥11 yr), transplant before 2006, male gender, BMI percentile for age ≥95%, and multiple transplantations (p < 0.05). The one-yr graft survival was significantly reduced in the group with lymphocele compared with control (81.2% vs. 92.51%, p < 0.04). This is the first pediatric report showing the following risk factors associated with post-transplant lymphocele: age ≥11 yr, male gender, BMI for age ≥95%, and multiple transplantations. A lymphocele can contribute to graft loss in the first-year post-transplant.
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Affiliation(s)
- Stefano Giuliani
- Department of Pediatric & Neonatal Surgery, St George's Healthcare NHS Trust and University, London, UK; Division of Pediatric Surgery, Department of 'Salute della Donna e del Bambino', University of Padova, Padova, Italy
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Pieloch D, Mann R, Dombrovskiy V, DebRoy M, Osband AJ, Mondal Z, Fernandez S, Laskow DA. The Impact of Morbid Obesity on Hospital Length of Stay in Kidney Transplant Recipients. J Ren Nutr 2014; 24:411-6. [DOI: 10.1053/j.jrn.2014.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 05/16/2014] [Accepted: 05/21/2014] [Indexed: 01/08/2023] Open
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DiCecco SR, Francisco-Ziller N. Obesity and organ transplantation: successes, failures, and opportunities. Nutr Clin Pract 2014; 29:171-91. [PMID: 24503157 DOI: 10.1177/0884533613518585] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The increasing rate of societal obesity is also affecting the transplant world through obesity in candidates and donors as well as its posttransplant repercussions. Being overweight and obese has been shown to have significant effects on both short- and long-term complications as well as patient and graft survival. However, much of the comorbidity can be controlled or prevented with careful patient selection and aggressive management. A team approach to managing obesity and its comorbidities both pre- and posttransplant is essential for successful transplant outcomes. Complicating understanding the results of obesity research is the inclusion different weight categories, use of listing vs transplant weights, patient populations large enough for statistical power, and changes in transplant management, especially immunosuppression protocols, anti-infection protocols, and operative techniques. Much more research is needed regarding many elements, including safe weight loss before transplantation, prevention of weight gain after transplant, genomic influences, and the role of bariatric surgery in the transplant process.
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Affiliation(s)
- Sara R DiCecco
- Sara R. DiCecco, Mayo Clinic Hospital-Rochester Methodist Campus, 201 West Center Street, Rochester, MN 55902, USA.
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Bolignano D, Zoccali C. Effects of weight loss on renal function in obese CKD patients: a systematic review. Nephrol Dial Transplant 2013; 28 Suppl 4:iv82-98. [PMID: 24092846 DOI: 10.1093/ndt/gft302] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Obesity is an independent risk factor for the development and progression of chronic kidney disease (CKD). We conducted a systematic review to assess the benefits of intentional weight loss in obese subjects with altered glomerular filtration rate (GFR), proteinuria or albuminuria. MEDLINE, EMBASE and CENTRAL databases were searched for articles reporting longitudinal data on the effect of weight loss on renal parameters in obese patients with altered kidney function. Thirty-one (2013 subjects) were included. In the 13 studies where weight loss was achieved by bariatric surgery, body mass index (BMI) significantly decreased in all studies; GFR decreased in six studies on hyperfiltration patients and increased in one study on patients with CKD Stage 3-4. Albuminuria decreased in six studies and proteinuria decreased in five studies. In six studies, weight loss was achieved by antiobesity agents: BMI decreased in all studies; GFR decreased in four studies and albuminuria in three. Eleven studies analysed the effects of diet, alone or in combination with lifestyle modifications. A significant decrease in BMI was reported in all studies; GFR increased in two studies, remained stable in four studies and decreased in two studies on hyperfiltration patients. Albuminuria decreased in six studies and remained stable in one study. Proteinuria decreased in five studies. In obese patients with altered renal function, weight loss, particularly if achieved by surgical interventions, improves proteinuria, albuminuria and normalizes GFR. Larger, long-term studies are needed to analyse the durability of this improvement and the effects on renal outcomes, such as CKD progression and the development of ESKD.
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Affiliation(s)
- Davide Bolignano
- Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension of Reggio Calabria, CNR-IBIM, Reggio Calabria, Italy
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Bardonnaud N, Pillot P, Lillaz J, Delorme G, Chabannes E, Bernardini S, Guichard G, Bittard H, Kleinclauss F. Outcomes of renal transplantation in obese recipients. Transplant Proc 2013; 44:2787-91. [PMID: 23146525 DOI: 10.1016/j.transproceed.2012.09.031] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Although obesity has been shown to paradoxically increase dialysis patient survival, its impact has not been clearly defined on renal transplantation. We assessed outcomes of obesity renal transplant patients by evaluating graft and patient survivals. PATIENTS AND METHODS A single-institution, retrospective study was performed on 202 renal transplant recipients from January 2004 to December 2008 excluding two combined kidney and liver transplantations. Recipients were classified based on body mass index (BMI) at the time of transplantation: obese (BMI ≥ 30 kg/m(2)) and nonobese recipients (BMI < 30 kg/m(2)). The comparative analysis included surgical complications, hospital stay, onset of delayed graft function (DGF), acute rejection episodes and graft patient survivals. RESULTS Twenty-one renal transplants were performed in obese recipients versus 179 in the control group. Obese patients were older (53.3 ± 11.2 versus 46.4 ± 14.4 years old; P = .035) and more often diabetic (29% ± 0.46 versus 60% ± 0.24, P = .001), but there were no differences among other combidities of high blood pressure, arteriopathy, thrombophilia, and smoking. Obesity did not appear to be a risk factor for urinary or vascular as well as parietal complications, but did tend to augment lymphatic complications (14.3% ± 0.36 versus 4.5% ± 0.21; P = .065). DGF occurred more frequently in obese patients (38% ± 0.50 versus 14% ± 0.34; P = .004) and hospital stays were therefore longer in this group (24.9 ± 23.53 days versus 15.6 ± 13.67 days; P = .008). Graft (hazard ratio [HR] 1.22; 95% confidence interval [CI] [0.25-6.0], P = .63) and patient survivals (HR:0,81; 95% CI [0.12- 5.3], P = .83) were comparable between the groups. CONCLUSION Obese patients seeking renal transplantation are usually older and more often diabetic compared with nonobese recipients. The higher rate of lymphatic complications and DGF lead to longer hospital stays among the group with BMI ≥ 30 kg/m(2). However, long-term results showed similar graft and patient survivals as nonobese patients. Consequently, there seemed to be no reason to avoid renal transplantation in obese recipients.
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Affiliation(s)
- N Bardonnaud
- Department of Urology and Renal Transplantation, University Hospital Saint-Jacques, Besançon, France
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Macauley R. Weighing potential candidates for kidney transplant: the ethics of exclusion for elevated body mass index. Prog Transplant 2013. [PMID: 23187054 DOI: 10.7182/pit2012291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
With more than 80 000 patients in the United States on waiting lists for a kidney-and more than 100 000 patients beginning treatment for end-stage renal disease each year-transplant programs must evaluate potential recipients in a fair and efficient manner. To this end, certain "absolute exclusion criteria" have been proposed to screen out candidates who will not sufficiently benefit from transplant. Some programs use elevated body mass index as such an exclusion criterion, given that some studies have reported an association with increased risk of delayed graft function and acute rejection, longer hospitalization, and decreased overall graft survival. Upon further examination, however, elevated body mass index turns out to be a poor evaluative criterion for transplant candidates, as it is only variably associated with negative transplant outcomes. Moreover, use of a body mass index cutoff is potentially discriminatory and may mask underlying prejudice against persons of size.
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Affiliation(s)
- Robert Macauley
- University of Vermont College of Medicine, Burlington, VT, USA.
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Khwaja A, El-Nahas M. Transplantation in the obese: separating myth from reality. Nephrol Dial Transplant 2012; 27:3732-5. [DOI: 10.1093/ndt/gfs406] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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