1
|
Carvalho Araújo I, Proença Vieira L, di Creddo Alves AC, Naoyuki Samano M, de Oliveira Braga Teixeira RH. Weight Gain and Acute Rejection in Patients Submitted to Pulmonary Transplantation: A Retrospective Cohort of 10 Years. Transplant Proc 2018; 50:804-808. [PMID: 29661442 DOI: 10.1016/j.transproceed.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Acute rejection is one of the most common complications after pulmonary transplantation. The aim of this work was to verify the association of nutritional status and weight gain with acute rejection in the recipient during the 1st year after pulmonary transplantation. METHODS Retrospective cohort study with patients submitted to pulmonary transplantation at a pulmonary transplantation center in the state of São Paulo. Data on sex, age, underlying disease, type of transplantation, and presence, degree, and frequency of rejection according to the transbronchial biopsy results were collected, along with body mass index (BMI) and weight variation over the course of 1 year. The difference between groups was analyzed by means of Student t test and the association by means of chi-square test. Significance was considered with P < .05. RESULTS A total of 117 patients were included, of which 71 (60.7%) were male. The average age was 39.8 ± 15.5 years. There were 77.8% with acute rejection in the 1st year after transplantation. The nutritional status of eutrophy prevailed according to BMI in both adolescents and adults, with no association with acute rejection (P = .80), and there was a greater weight gain among the individuals who showed rejection, with an increase of 7.58 kg (95% confidence interval [CI] 6.35-8.81) compared with those who did not present rejection, whose average weight gain was 4.12 kg (95% CI 1.28-6.95; P = .01). CONCLUSIONS Nutritional status was not associated with acute cell rejection in the 1st year after transplantation, although weight gain was greater in those who had rejection.
Collapse
Affiliation(s)
- I Carvalho Araújo
- Nutrition and Dietetics Department, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - L Proença Vieira
- Nutrition and Dietetics Department, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - A C di Creddo Alves
- Nutrition and Dietetics Department, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - M Naoyuki Samano
- Pulmonary Transplantation Department, Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - R H de Oliveira Braga Teixeira
- Pulmonary Transplantation Department, Thoracic Surgery Division, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Molnar MZ, Nagy K, Remport A, Gaipov A, Fülöp T, Czira ME, Kovesdy CP, Mucsi I, Mathe Z. Association Between Serum Leptin Level and Mortality in Kidney Transplant Recipients. J Ren Nutr 2016; 27:53-61. [PMID: 27666945 DOI: 10.1053/j.jrn.2016.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Leptin is a hormone made by adipocytes and associated with hypertension, inflammation, and coronary artery disease. Low serum leptin level was associated with higher risk of death in patients with advanced chronic kidney disease. Little is known about the association of serum leptin with outcomes in kidney transplant recipients. DESIGN Prospective prevalent cohort. SETTING AND SUBJECT We collected sociodemographic and clinical parameters, medical and transplant history, and laboratory data of 979 prevalent kidney transplant recipients. Associations between serum leptin level and death with a functioning graft, all-cause death, and death-censored graft loss over a 6-year follow-up period were examined in survival models. RESULTS Serum leptin levels showed moderate negative correlation with eGFR (R = -0.21, P < .001) and positive correlations with BMI (R = 0.48, P < .001) and C-reactive protein (R = 0.20, P < .001). Each 10 ng/mL higher serum leptin level was associated with 7% lower risk of death with functioning graft (hazard ratio [HR] (95% confidence interval [CI]), 0.93 (0.87-0.99)), and this association persisted after adjustment for confounders: HR (95% CI), 0.90 (0.82-0.99). Similar associations were found with all-cause death as outcome. The association between serum leptin level and risk of graft loss was nonlinear, and only low serum leptin level was associated with higher risk of graft loss. CONCLUSIONS In prevalent kidney transplant recipients, lower serum leptin was an independent predictor of death.
Collapse
Affiliation(s)
- Miklos Z Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
| | - Kristof Nagy
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Adam Remport
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Abduzhappar Gaipov
- Department of Extracorporeal Hemocorrection, National Scientific Medical Research Center, Astana, Kazakhstan
| | - Tibor Fülöp
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Maria E Czira
- Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
| | - Csaba P Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee; Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - Istvan Mucsi
- Department of Medicine, Division of Nephrology and Multiorgan Transplant Program, University Health Network, University of Toronto, Toronto, Canada
| | - Zoltan Mathe
- Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| |
Collapse
|
3
|
Nagy K, Nagaraju SP, Rhee CM, Mathe Z, Molnar MZ. Adipocytokines in renal transplant recipients. Clin Kidney J 2016; 9:359-73. [PMID: 27274819 PMCID: PMC4886901 DOI: 10.1093/ckj/sfv156] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/18/2015] [Indexed: 02/07/2023] Open
Abstract
In the last two decades, perceptions about the role of body fat have changed. Adipocytes modulate endocrine and immune homeostasis by synthesizing hundreds of hormones, known as adipocytokines. Many studies have been investigating the influences and effects of these adipocytokines and suggest that they are modulated by the nutritional and immunologic milieu. Kidney transplant recipients (KTRs) are a unique and relevant population in which the function of adipocytokines can be examined, given their altered nutritional and immune status and subsequent dysregulation of adipocytokine metabolism. In this review, we summarize the recent findings about four specific adipocytokines and their respective roles in KTRs. We decided to evaluate the most widely described adipocytokines, including leptin, adiponectin, visfatin and resistin. Increasing evidence suggests that these adipocytokines may lead to cardiovascular events and metabolic changes in the general population and may also increase mortality and graft loss rate in KTRs. In addition, we present findings on the interrelationship between serum adipocytokine levels and nutritional and immunologic status, and mechanisms by which adipocytokines modulate morbidity and outcomes in KTRs.
Collapse
Affiliation(s)
- Kristof Nagy
- Department of Transplantation and Surgery , Semmelweis University , Budapest , Hungary
| | | | - Connie M Rhee
- Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension , University of California Irvine , Orange, CA , USA
| | - Zoltan Mathe
- Department of Transplantation and Surgery , Semmelweis University , Budapest , Hungary
| | - Miklos Z Molnar
- Division of Nephrology, Department of Medicine , University of Tennessee Health Science Center , Memphis, TN , USA
| |
Collapse
|
4
|
Lee MC, Lee CJ, Ho GJ, Lee CC, Shih MH, Chou KC, Hsu BG. Hyperleptinemia positively correlated with metabolic syndrome in renal transplant recipients. Clin Transplant 2011; 24:E124-9. [PMID: 20236136 DOI: 10.1111/j.1399-0012.2010.01215.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Our aim was to evaluate the relationship between metabolic syndrome and fasting serum leptin concentration in renal transplant recipients. PATIENTS AND METHODS Fasting blood samples were obtained from 55 renal transplant recipients. Metabolic syndrome and its components were defined using the diagnostic criteria of the International Diabetes Federation. RESULTS Thirteen patients (23.6%) had metabolic syndrome. Fasting leptin concentrations were positively correlated with metabolic syndrome (p=0.003). Univariate linear regression analysis indicated fasting serum leptin values were positively correlated with waist circumference (r=0.284; p=0.036), body mass index (r=0.358; p=0.007), body fat mass (r=0.610; p<0.001), triglycerides (r=0.268; p=0.048), high-sensitivity C-reactive protein (hs-CRP) (r=0.377; p=0.005), triceps skinfold (r=0.335; p=0.012), and mid-arm fat area (r=0.351; p=0.009). Multivariate forward stepwise linear regression analysis of the significant variables revealed that body fat mass (R2 change=0.373; p<0.001) and hs-CRP (R2 change=0.045; p=0.049) were the independent predictors of fasting serum leptin concentration. CONCLUSION Serum leptin concentration correlates positively with metabolic syndrome in renal transplant recipients.
Collapse
Affiliation(s)
- Ming-Che Lee
- School of Medicine, Tzu Chi University Department of Surgical Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | | | | | | | | | | | | |
Collapse
|
5
|
Agras PI, Saatci U, Baskin E, Ozbek N, Cengiz N, Colak T, Karakayali H, Haberal A, Haberal M. Hyperleptinemia and its relation with peripheral C34(+)CD7(+) stem cells in renal transplant recipients. Transpl Immunol 2005; 15:241-5. [PMID: 16431293 DOI: 10.1016/j.trim.2005.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2005] [Revised: 09/06/2005] [Accepted: 09/09/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Leptin, the Ob gene product, centrally regulates weight control. Transplant recipients are exposed to many factors affecting body mass. Leptin has been reported to activate the peripheral immune system. In this study, we evaluated serum leptin levels and factors contributing to hyperleptinemia; the relationship between serum leptin levels and lymphoid stem and mature cells; and their role in the rejection process in renal transplant recipients. MATERIALS AND METHODS Sixty-three renal transplant recipients were included in the study. Patients were grouped according to serum leptin percentiles as hypoleptinemic (n=17), normoleptinemic (n=32), and hyperleptinemic (n=14). We determined serum leptin levels by radioimmunoassay and absolute number of CD34(+), CD7(+), CD34(+)CD7(+) lymphoid stem cells, CD4(+) and CD8(+) lymphocytes in peripheral blood by flow cytometry. RESULTS The hyperleptinemic patients constituted 22.3% of the transplant patient. The mean peripheral blood CD34(+)CD7(+) lymphocyte count was significantly higher in hyperleptinemic patients than in normo- or hypoleptinemic patients (6.9, 6.1, and 44.3 cells/mm(3), respectively, P<0.05). There were no significant differences in the mean CD34(+), CD7(+), CD8(+), and CD4(+) lymphocyte count and CD4/CD8 ratio among the groups with respect to serum leptin levels. CD34(+)CD7(+) lymphocyte count was positively correlated with serum leptin levels (r=0.416, P<0.05). CONCLUSIONS Hyperleptinemia is not rare during the posttransplant period. Our data support the results of previous experimental studies that have demonstrated the effect of the leptin hormone on lymphoid stem cells. The central and peripheral effects of leptin may differ on lymphoid stem cells and a serum threshold level may apply for the central effects.
Collapse
Affiliation(s)
- Pinar Isik Agras
- Baskent University, Deparment of Pediatric Nephrology, Ankara, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Singer LG, Brazelton TR, Doyle RL, Morris RE, Theodore J. Weight gain after lung transplantation. J Heart Lung Transplant 2003; 22:894-902. [PMID: 12909470 DOI: 10.1016/s1053-2498(02)00807-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Weight gain is frequently observed after lung transplantation, but the magnitude, predictors and implications of weight gain after lung transplant are unknown. METHODS This retrospective cohort study included 826 lung transplant recipients randomly selected from 12 international transplant centers. We included adult patients with available weight data at baseline and 1 year post-transplant. We examined demographic and clinical predictors of first year weight gain using a multiple linear regression model (n = 579) with percent weight change as the dependent variable. To study the association between first year weight gain and subsequent survival, we performed a Cox proportional hazards analysis. p < 0.05 was considered statistically significant. RESULTS The median weight change was 10% (range -32% to 84%). On multi-variate analysis, increasing age and prolonged mechanical ventilation were inversely associated with weight gain; obstructive disease, interstitial disease and increasing ischemic time were positively associated with weight gain. Increasing baseline weight was negatively associated with weight gain in patients with obstructive and interstitial disease. The model accounted for 14% of the variance in weight gain. Patients with weight gain above the median had better subsequent survival (adjusted hazard ratio 0.61, 95% confidence interval 0.41 to 0.90). Infection was a more common cause of death in these patients, whereas malignant deaths were more frequent in patients with below-median weight gain. CONCLUSIONS Substantial weight gain occurs in the first year after lung transplantation. The predictors of weight gain may be used to target high-risk patients for early intervention. Higher weight gain is associated with better subsequent survival.
Collapse
Affiliation(s)
- Lianne G Singer
- Division of Pulmonary and Critical Care Medicine, Stanford University School of Medicine, Stanford, California, USA.
| | | | | | | | | |
Collapse
|