Increased Recipient Body Mass Index Is Associated With Acute Rejection and Other Adverse Outcomes After Kidney Transplantation (original) (raw)
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Clinical Transplantation, 2010
Papalia T, Greco R, Lofaro D, Maestripieri S, Mancuso D, Bonofiglio R. Impact of body mass index on graft loss in normal and overweight patients: retrospective analysis of 206 renal transplants. Clin Transplant 2010: 24: E241–E246. © 2010 John Wiley & Sons A/S.Abstract: Background: Excess body mass is increasingly prevalent in transplant recipients. Currently, most investigators consider body mass index (BMI) a categorical variable, which assumes that all risk factors and transplant outcomes will be similar in all patients within the same category. We investigated the effect of categorical and continuous BMI increments on renal transplant outcome in normal weight (NW: BMI 18.5–24.9) and overweight (OW: BMI 25–30) patients.Methods: We retrospectively studied 206 patients. The mean BMI of our population was 24.3 ± 2.83 kg/m2. Patients of each group were similar regarding age, gender, time on dialysis, donor type, cold ischemia time, and number of HLA mismatches. The independent association of BMI with survival was determined using Cox multivariate regression.Results: OW patients showed a higher prevalence of co-morbidities. In patients with graft loss, there was a higher incidence of delayed graft function, chronic allograft nephropathy, acute rejection, and hypertension. Graft survival was significantly lower in OW patients compared to NW patients upon Kaplan–Meier analysis (p = 0.008). In a multivariate Cox regression analysis, the initial BMI, evaluated as a continuous variable, remained an independent predictor of graft loss (hazard ratio 1.21, 95% CI 1.04–1.47). However, with patient stratification into World Health Organization BMI category and, further, into quartiles of initial BMI, no significant correlation between BMI category and graft loss was found.Conclusion: We suggest that increasing BMI value, although without categorical variation, may represent an independent risk factor for graft loss. Our retrospective analysis of a small sample population will require further studies to confirm these data.
Transplantation Proceedings, 2005
Body mass index (BMI) is strongly associated with outcomes in renal transplantation, independent of other risk factors. The aim of this study was to evaluate the impact of low BMI on graft survival in renal transplant recipients. The demographic and laboratory data as well as presence of acute or chronic rejection were retrospectively obtained for 115 recipients (80 men, 35 women) of mean age 34.56 Ϯ 11.14 years with posttransplantation follow-up duration of 5 years. Pretransplantation and one year posttransplantation BMIs were calculated. Patients were stratified to 2 groups according to their posttransplantation BMIs: group 1 had BMIs Ͻ19 kg/m 2 (17.8 Ϯ 1.0; n ϭ 23), and group 2 had BMIs Ն 19 kg/m 2 (23.7 Ϯ 1.8; n ϭ 92). Twenty (87.0%) of 23 patients had low pretransplantation BMIs (P Ͻ .0001). Although mean serum creatinine levels at discharge after transplantation were lower among the low-BMI group (P Ͻ .03), the fifth-year levels were significantly higher in this group than in the normal-BMI group (P ϭ .01). Follow-up serum albumin, triglyceride, and cholesterol levels were lower in group 1. According to the 5-year data, the percentages of recipients who suffered from chronic rejection (73.9% vs 20.7%; P Ͻ .001) and graft loss (73.9% vs 31.5%; P Ͻ .001) were significantly higher among group 1 than group 2. Multivariate backward analysis disclosed that BMI was closely associated with chronic rejection (P Ͻ 0.0001; odds ratio ϭ 14.5; 95% confidence interval 4.3-49.6). In conclusion, a low BMI is an adverse prognostic factor after transplantation. To improve graft outcome, we recommend pretransplantation evaluation of recipient metabolic status, as well as early intensive dietary advice and follow-up for normalization of BMI.
Recipient and donor body mass index as important risk factors for delayed kidney graft function
Transplantation, 2012
BACKGROUND.: Obesity is increasingly impacting the overall health status and the global costs for health care. The increase in body mass index (BMI) is also observed in kidney allograft recipients and deceased organ donors. METHODS.: In a retrospective single-center study, we analyzed 1132 deceased donor kidney grafts, transplanted at our institution between 2000 and 2009 for recipient and donor BMI and its correlation with delayed graft function (DGF). Recipients/donors were classified according to their BMI (<18.5, 18.5-24.9, 25-29.9, and >30 kg/m). DGF was defined as requirement for one dialysis within the first week after transplantation. RESULTS.: Overall DGF rate was 32.4%, mean recipient BMI was 23.64±3.75 kg/m, and mean donor BMI was 24.69±3.44 kg/m. DGF rate was 25.2%, 29.8%, 40.9%, and 52.6% in recipients with BMI less than 18.5, 18.5 to 24.9, 25 to 29.9, and more than 30 kg/m, respectively (P<0.0001). Donor BMI less than 18.5, 18.5 to 24.9, 25 to 29.9, more than ...
Effect of Degree of Obesity on Renal Transplant Outcome
Transplantation Proceedings, 2008
Obesity in renal transplantation has proven to affect both patient and graft survival. The scientific community seems to be split into 2 groups: one claims similar outcomes among obese and nonobese, showing only marginally increased postoperative complications; whereas the other group report a higher rate of complications, including graft loss and mortality. These results did not provide sufficient evidence to be applied in practice. In this study we analyzed the outcomes of obese recipients of renal transplant in our institution. One hundred fourteen renal transplantations were performed between January 1993 and December 2003. To estimate the impact of various degrees of obesity, the patients were allocated into 2 cohorts: Group A (body mass index [BMI] 30 -34.9) and Group B (BMI 35 and greater). We analyzed patient and donor characteristics. Wound infection rates were similar in the 2 groups. The aggregate Group A and B patient survival rate was 95.6% at 1 year and 93% at 5 years. Graft survival rate was 93.9% at 1 year and 88% at 5 years. However, the analysis of the outcomes in the 2 groups with different degrees of obesity showed that the patient survival rate at 1 year in Group A was 98.9% (1 death) and 95.6% at 5 years (4 deaths). In Group B the patient survival rate at 1 year was 87.5% (3 deaths; P ϭ .007) and at 5 years was 79.2% (P ϭ .006). Graft survival rate in Group A was 98.9% (1 graft loss) at 1 year and 94.5% (5 graft losses) at 5 years; in Group B the graft survival rate was 75% (6 graft loss) at 1 year and 63% (9 graft losses) at 5 years (P Ͻ .0001 both at 1 and 5 years). The present study showed that overall obese recipient outcomes were as expected when evaluating the obese as a single group of recipients with a BMI Ͼ30. The overall patient and graft survival did not show particularly different results from already published studies claiming similar outcomes. However, this series showed different outcomes when we divided them into 2 groups by BMI. There was a remarkable difference between moderate obese (Group A) and morbid obese (Group B) recipients as regards patient and graft survival. It is possible that the excellent outcome in Group A may be the result of super-selection and stringent cardiovascular risk screening that is implemented for this category of potential recipients. Obese recipients with a BMI of Ͼ35 are a high-risk category. Because of the difference in the outcomes of the 2 groups, it does not seem reasonable to address obese recipients as a single group. We believe that obese patients should not be discriminated simply on the basis of the BMI. A strict evaluation should be performed before denying the opportunity to receive a renal transplant to these patients.
Pretransplantation Overweight and Obesity: Does It Really Affect Kidney Transplantation Outcomes?
Transplantation Proceedings, 2011
Objective. The objective of this study was to compare kidney transplant outcomes among pretransplantation overweight and obese patients with those with normal weight. Methods. We performed a retrospective analysis of a sample of 448 kidney transplantations performed between 1984 and 2008 in our institution. We compared of initial graft function, postoperative length of stay, surgical complications, acute and chronic rejection rates, creatinine serum levels, and patient and graft survival, between normal weight, overweight, and obesity groups.
The Role of Obesity in Kidney Transplantation Outcome
Transplantation Proceedings, 2012
BACKGROUND: The number of obese kidney transplant candidates has been growing. However, there are conflicting results regarding to the effect of obesity on kidney transplantation outcome.
Obesity and Outcome Following Renal Transplantation
American Journal of Transplantation, 2006
Single institution series have demonstrated that obese patients have higher rates of wound infection and delayed graft function (DGF), but similar rates of graft survival. We used UNOS data to determine whether obesity affects outcome following renal transplantation.From the UNOS database, we identified patients who underwent primary kidney-only transplantation between 1997 and 1999. Recipient and donor body mass index (BMI) was categorized as underweight (BMI < 18.5), normal (BMI 18.5–24.9), overweight (BMI 25–29.9), obese (BMI 30–34.9) or morbidly obese (BMI ≥ 35). We correlated BMI with intermediate measures of graft outcome and overall graft survival, and created multivariate models to evaluate the independent effect of BMI on graft outcome, adjusting for factors known to affect graft success.The study sample comprised 27 377 recipients. Older age, female sex, African American race and increased comorbidity were associated with obesity (p < 0.001). Compared with normal weight patients, morbid obesity was independently associated with an increased risk of DGF (p < 0.001), prolonged hospitalization (p < 0.001), acute rejection (p = 0.006) and decreased overall graft survival (p = 0.001). Donor BMI did not affect overall graft survival (p ≥ 0.07).Recipient obesity is associated with an increased risk of DGF and decreased graft survival following renal transplantation.