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Rademacher S, Brunotte M, Wichmann Y, Mehdorn M, Kaths JM, Seehofer D, Sucher R, Scheuermann U. Effect of Pre-Transplant Recipient Underweight on the Postoperative Outcome and Graft Survival in Primary Kidney Transplantation. Transplant Proc 2023; 55:1521-1529. [PMID: 37385839 DOI: 10.1016/j.transproceed.2023.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/21/2023] [Accepted: 04/14/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the influence of recipient underweight on the short- and long-term outcomes of patients undergoing primary kidney transplantation (KT). PATIENTS AND METHODS Three hundred thirty-three 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 underweight (BMI <18.5 kg/m2; N = 29) and normal weight (BMI 18.5-24.9 kg/m2; N = 304) groups. Clinicopathological characteristics, postoperative outcomes, and graft and patient survival were analyzed retrospectively. RESULTS The postoperative rate of surgical complications and renal function were comparable between the groups. One year and 3 years after KT, 70% and 92.9%, respectively, of the pre-transplant underweight patients reached a normal BMI (≥18.5 kg/m2). The mean death-censored graft survival was significantly lower in pre-transplant underweight patients than in pre-transplant normal-weight patients (11.5 ± 1.6 years vs 16.3 ± 0.6 years, respectively; P = .045). Especially KT recipients with a moderate or severe pre-transplant underweight (BMI <17 kg/m2; N = 8) showed an increased rate of graft loss (5- and 10-year graft survival: 21.4% each). No statistical difference could be observed between the 2 groups regarding causes of graft loss. In multivariate analysis, recipient underweight (P = .024) remained an independent prognostic factor for graft survival. CONCLUSION Being underweight did not affect the early postoperative outcome after primary KT. However, underweight, and especially moderate and severe thinness, is associated with reduced long-term kidney graft survival, and therefore this group of patients should be monitored with special attention.
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Affiliation(s)
- Sebastian Rademacher
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Maximilian Brunotte
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Yannis Wichmann
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Matthias Mehdorn
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - J Moritz Kaths
- Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Daniel Seehofer
- 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
| | - Uwe Scheuermann
- 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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Tang L, Lee T, Yuen L, Pleass H. Renal allograft compartment syndrome: a review. ANZ J Surg 2021; 91:2606-2609. [PMID: 34755448 DOI: 10.1111/ans.17271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 08/29/2021] [Accepted: 09/28/2021] [Indexed: 11/28/2022]
Abstract
Renal allograft compartment syndrome (RACS) is the result of extrinsic compression resulting in graft dysfunction and loss due to ischaemia. A literature review was performed by computerized searches from the following data sources Medline, EMBASE, PubMed and Cochrane Library databases. Risk factors include size mismatch between graft and recipient. Intraoperative suspicion should be exercised if there is poor tissue turgor, cyanosis and loss of urine output upon fascial closure. Doppler ultrasound is the modality of choice amongst the literature to aid in diagnosis of RACS. From our study, the accepted form of treatment is early detection and appropriate surgical intervention. Nevertheless, it is clear from the paucity of literature that further investigation into this area of transplantation is necessary.
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Affiliation(s)
- Linda Tang
- Department of Transplant Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Taina Lee
- Department of Transplant Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Lawrence Yuen
- Department of Transplant Surgery, Westmead Hospital, Westmead, New South Wales, Australia
| | - Henry Pleass
- Department of Transplant Surgery, Westmead Hospital, Westmead, New South Wales, Australia.,Division of Surgery, University of Sydney, Sydney, Australia
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Grèze C, Pereira B, Boirie Y, Guy L, Millet C, Clerfond G, Garrouste C, Heng AE. Impact of obesity in kidney transplantation: a prospective cohort study from French registries between 2008 and 2014. Nephrol Dial Transplant 2021; 37:584-594. [PMID: 34610103 DOI: 10.1093/ndt/gfab277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The access of obese patients to kidney transplantation is limited despite several studies showing that obese transplant recipients had a better survival rate than those undergoing dialysis. The aim of this study was to compare patient and graft survival rates and post-renal transplant complications in obese patients and non-obese patients and to assess the effect of pre-transplant weight loss in obese patients on transplant outcomes. METHODS We carried out a prospective cohort study using two French registries REIN and CRISTAL on 7 270 kidney transplant patients between 2008 and 2014 in France. We compared obese patients with non-obese patients and obese patients who lost more than 10% of weight before the transplant (Obese WL and Obese nWL). RESULTS The mean BMI in our obese patients was 32 kg/m2. Graft survival was lower in obese patients than in non-obese patients (HR = 1.40, IC 95% [1.09; 1.78], P = 0.007) whereas patient survival was similar (HR = 0.94, IC 95% [0.73; 1.23], P = 0.66). Graft survival was significantly lower in Obese WL than in Obese nWL (HR = 2.17, CI 95% [1.02; 4.63], P = 0.045) whereas patient survival was similar in the two groups (HR = 0.79, IC 95% [0.35; 1.77], P = 0.56). CONCLUSION Grade I obesity does not seem to be a risk factor for excess mortality after kidney transplantation and should not be an obstacle to having access to a graft. Weight loss before a kidney transplant in this patients should not be essential for registration on waiting list.
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Affiliation(s)
- Clarisse Grèze
- Service de Néphrologie, Dialyse et Transplantation, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Unité de Biostatistiques (DRCI), CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Yves Boirie
- Service de Nutrition clinique, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Laurent Guy
- Service d'Urologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Clémentine Millet
- Service d'Urologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Guillaume Clerfond
- Service de Cardiologie, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Cyril Garrouste
- Service de Néphrologie, Dialyse et Transplantation, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne-Elisabeth Heng
- Service de Néphrologie, Dialyse et Transplantation, CHU de Clermont-Ferrand, Clermont-Ferrand, France
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Flabouris K, Chadban S, Ladhani M, Cervelli M, Clayton P. Body mass index, weight-adjusted immunosuppression and the risk of acute rejection and infection after kidney transplantation: a cohort study. Nephrol Dial Transplant 2020; 34:2132-2143. [PMID: 31168571 DOI: 10.1093/ndt/gfz095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/15/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Body mass index (BMI) is associated with patient outcomes after kidney transplantation. We hypothesized that immunosuppression (IS) dosing is a contributing factor. METHODS Using Australia and New Zealand Dialysis and Transplant registry data, we included all adult kidney-only transplant recipients over 2000-14 treated with prednisolone, mycophenolate and tacrolimus/cyclosporin (n = 7919). The exposure was BMI and the outcomes were time to: (i) acute rejection, (ii) fatal infection, (iii) cancer and (iv) graft; and (v) patient survival. We modelled BMI and IS dosing (in quartiles) as time-varying covariates in extended Cox models. RESULTS Compared with a BMI of 25 kg/m2, a BMI of 35 was associated with acute rejection after adjusting for demographics and comorbidities [adjusted hazard ratio (aHR) = 1.29, 95% confidence interval (CI) 1.12-1.49]. This association virtually disappeared after correcting for IS (aHR = 1.09, 95% CI 0.93-1.29). A BMI of 35 was non-significantly associated with fewer fatal infections (aHR = 0.91, 95% CI 0.66-1.25), but this reversed after adjusting for IS (aHR = 1.54, 95% CI 1.03-2.28). Results for cancer were not significantly altered after adjusting for IS. Results for lower BMI were similarly not significantly altered though generally associated with worse outcomes. CONCLUSIONS Our findings show that the associations between high BMI, acute rejection and fatal infection after kidney transplantation were significantly altered after correcting for IS suggesting that relative under-dosing of obese patients may partially explain these associations.
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Affiliation(s)
- Katerina Flabouris
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Steven Chadban
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,School of Medicine, The University of Sydney, Camperdown, Australia.,Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Maleeka Ladhani
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,School of Medicine, The University of Sydney, Camperdown, Australia.,Department of Renal Medicine, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Matthew Cervelli
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Philip Clayton
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
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Carvalho JA, Nunes P, Antunes H, Parada B, Tavares da Silva E, Rodrigues L, Roseiro A, Bastos C, Macário F, Figueiredo A. Surgical Complications in Kidney Transplantation: An Overview of a Portuguese Reference Center. Transplant Proc 2019; 51:1590-1596. [PMID: 31155198 DOI: 10.1016/j.transproceed.2019.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Kidney transplantation (KT) is a surgery performed worldwide and has some complications. The objective of this study is to evaluate our surgical complications, comparing the outcomes with those KTs without surgical complications. PATIENTS AND METHODS An observational cross-sectional study of all surgical complications among 3102 kidney transplants performed between June 1980 and April 2018. RESULTS Of 3102 kidney transplantations, 490 (15.8%) had the following complications: surgical complications (n = 527); urinary (n = 184; 5.9%); vascular (n = 140; 4.5%); wound-related (n = 78; 2.5%); lymphocele (n = 56; 1.8%); and others (n = 69; 2.2%). The most common complications were ureteral obstruction (n = 85; 2.7%) and urinary fistula (n = 72; 2.3%). The immunosuppression regimen did not influence the surgical complications rate. Surgical complications mainly occurred in male (71.4% vs 66.7%) and heavier (67.6 ± 13.9 vs 65.9 ± 13.5 kg) recipients (P < .05). The hospitalization time was also different (26.3 ± 30.6 vs 15.0 ± 38.8 days, P < .05). Serum creatinine values were different until the second year. After that, the renal function was approximately the same. Nearly 26.1% of complicated kidney transplants had delayed graft function (vs 14.8%, P < .001). Only 23.9% of complicated kidney transplants needed transplant nephrectomy (vs 6.2%, P < .001). The survival of kidneys with surgical complications was lower (64.2 ± 4.5 vs 94.09 ± 2.6 months, P < .001). DISCUSSION/CONCLUSION Kidney transplant surgical complications occur over time, especially urinary and vascular complications, remaining a problem that leads to prolonged hospitalization and decreased graft survival.
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Affiliation(s)
- João André Carvalho
- Urology and Renal Transplantation Department, Coimbra University Hospital Center, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal.
| | - Pedro Nunes
- Urology and Renal Transplantation Department, Coimbra University Hospital Center, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Hugo Antunes
- Urology and Renal Transplantation Department, Coimbra University Hospital Center, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Belmiro Parada
- Urology and Renal Transplantation Department, Coimbra University Hospital Center, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Edgar Tavares da Silva
- Urology and Renal Transplantation Department, Coimbra University Hospital Center, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Luís Rodrigues
- Urology and Renal Transplantation Department, Coimbra University Hospital Center, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - António Roseiro
- Urology and Renal Transplantation Department, Coimbra University Hospital Center, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Carlos Bastos
- Urology and Renal Transplantation Department, Coimbra University Hospital Center, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Fernando Macário
- Urology and Renal Transplantation Department, Coimbra University Hospital Center, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Arnaldo Figueiredo
- Urology and Renal Transplantation Department, Coimbra University Hospital Center, Coimbra, Portugal; Faculty of Medicine, Coimbra University, Coimbra, Portugal
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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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Pazik J, Lewandowski Z, Nowacka Cieciura E, Ołdak M, Podgórska M, Sadowska A, Dęborska Materkowska D, Durlik M. Malnutrition Risk in Kidney Recipients Treated With Mycophenolate Mofetil Is Associated With IMPDH1 rs2278294 Polymorphism. Transplant Proc 2018; 50:1794-1797. [DOI: 10.1016/j.transproceed.2018.02.125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 02/19/2018] [Indexed: 12/14/2022]
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Veasey TM, Fleming JN, Strout SE, Miller R, Pilch NA, Meadows HB, Mardis CR, Mardis BA, Shenvi S, McGillicuddy J, Chavin KD, Baliga P, Taber DJ. Morbid obesity and functional status as predictors of surgical complication after renal transplantation. Am J Surg 2018. [DOI: 10.1016/j.amjsurg.2017.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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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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Ashby VB, Leichtman AB, Rees MA, Song PXK, Bray M, Wang W, Kalbfleisch JD. A Kidney Graft Survival Calculator that Accounts for Mismatches in Age, Sex, HLA, and Body Size. Clin J Am Soc Nephrol 2017; 12:1148-1160. [PMID: 28596416 PMCID: PMC5498352 DOI: 10.2215/cjn.09330916] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/27/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Outcomes for transplants from living unrelated donors are of particular interest in kidney paired donation (KPD) programs where exchanges can be arranged between incompatible donor-recipient pairs or chains created from nondirected/altruistic donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using Scientific Registry of Transplant Recipients data, we analyzed 232,705 recipients of kidney-alone transplants from 1998 to 2012. Graft failure rates were estimated using Cox models for recipients of kidney transplants from living unrelated, living related, and deceased donors. Models were adjusted for year of transplant and donor and recipient characteristics, with particular attention to mismatches in age, sex, human leukocyte antigens (HLA), body size, and weight. RESULTS The dependence of graft failure on increasing donor age was less pronounced for living-donor than for deceased-donor transplants. Male donor-to-male recipient transplants had lower graft failure, particularly better than female to male (5%-13% lower risk). HLA mismatch was important in all donor types. Obesity of both the recipient (8%-18% higher risk) and donor (5%-11% higher risk) was associated with higher graft loss, as were donor-recipient weight ratios of <75%, compared with transplants where both parties were of similar weight (9%-12% higher risk). These models are used to create a calculator of estimated graft survival for living donors. CONCLUSIONS This calculator provides useful information to donors, candidates, and physicians of estimated outcomes and potentially in allowing candidates to choose among several living donors. It may also help inform candidates with compatible donors on the advisability of joining a KPD program.
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Affiliation(s)
- Valarie B. Ashby
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Alan B. Leichtman
- Arbor Research Collaborative for Health, Division of Nephrology, University of Michigan, Ann Arbor, Michigan; and
| | - Michael A. Rees
- Departments of Urology and Pathology, University of Toledo Medical Center, Toledo, Ohio
| | - Peter X.-K. Song
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Mathieu Bray
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Wen Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
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Liese J, Bottner N, Büttner S, Reinisch A, Woeste G, Wortmann M, Hauser IA, Bechstein WO, Ulrich F. Influence of the recipient body mass index on the outcomes after kidney transplantation. Langenbecks Arch Surg 2017; 403:73-82. [PMID: 28493145 DOI: 10.1007/s00423-017-1584-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 04/28/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE The relationship between the body mass index (BMI) of kidney transplant recipients and outcomes after kidney transplantation (KT) is not fully understood and remains controversial. We studied the influence of BMI on clinically relevant outcomes in kidney transplant recipients. METHODS In this retrospective single-centre study, all patients who underwent kidney transplantation at our institution between January 2007 and December 2012 were included. Demographic data and BMI were correlated with the clinical course of the disease, rejection rates, delayed graft function rates, and graft and patient survival. RESULTS During the study period, 384 single KTs (130 women and 254 men) were performed. Seventeen percent of the transplants were transplanted within the Eurotransplant Senior Programme (ESP). Most of the transplants were performed using organs that were obtained from donors after brain death (DBD), and living donor kidney transplants were performed in 22.4% of all transplants. The median BMI of the recipients was 25.9 kg/m2. Additionally, 13.5% of the recipients had a BMI of 30-34.9 kg/m2 and 3.9% had a BMI >35 kg/m2. A BMI >30 kg/m2 was significantly associated with primary non-function of the kidney (p = 0.047), delayed graft function (p = 0.008), and a higher rate of loss of graft function (p = 0.015). The glomerular filtration rate 12 months after KT was significantly lower in recipients with a BMI >30 kg/m2. Multivariate analysis revealed that recipient BMI, among other factors, was an independent risk factor for delayed graft function and graft survival. Patients with a BMI >30 kg/m2 had an almost four times higher risk for surgical site infection than did recipients with a lower BMI. CONCLUSIONS Increased BMI at kidney transplantation is a predictor of adverse outcomes, including delayed graft function. These findings demonstrate the importance of the careful selection of patients and pre-transplant weight reduction, although the role of weight reduction for improving graft function is not clear.
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Affiliation(s)
- Juliane Liese
- Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Nils Bottner
- Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Stefan Büttner
- Medical Clinic III, Department of Nephrology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Alexander Reinisch
- Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Guido Woeste
- Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Markus Wortmann
- Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Ingeborg A Hauser
- Medical Clinic III, Department of Nephrology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Wolf Otto Bechstein
- Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Frank Ulrich
- Department of General and Visceral Surgery, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.,Department of General, Visceral and Oncological Surgery, Wetzlar Hospital and Clinics, Wetzlar, Germany
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A Clinical Prediction Score to Guide Referral of Elderly Dialysis Patients for Kidney Transplant Evaluation. Kidney Int Rep 2017; 2:645-653. [PMID: 28845472 PMCID: PMC5568833 DOI: 10.1016/j.ekir.2017.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Dialysis patients aged ≥70 years derive improved life expectancy through kidney transplantation compared to their waitlisted counterparts, but guidelines are not clear about how to identify appropriate transplantation candidates. We developed a clinical prediction score to identify elderly dialysis patients with expected 5-year survival appropriate for kidney transplantation (>5 years). METHODS Incident dialysis patients in 2006-2009 aged ≥70 were identified from the United States Renal Data System database and divided into derivation and validation cohorts. Using the derivation cohort, candidate variables with a significant crude association with 5-year all-cause mortality were included in a multivariable logistic regression model to generate a scoring system. The scoring system was tested in the validation cohort and a cohort of elderly transplant recipients. RESULTS Characteristics most predictive of 5-year mortality included age >80, body mass index (BMI) <18, the presence of congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), immobility, and being institutionalized. Factors associated with increased 5-year survival were non-white race, a primary cause of end stage renal disease (ESRD) other than diabetes, employment within 6 months of dialysis initiation, and dialysis start via arteriovenous fistula (AVF). 5-year mortality was 47% for the lowest risk score group (3.6% of the validation cohort) and >90% for the highest risk cohort (42% of the validation cohort). CONCLUSION This clinical prediction score could be useful for physicians to identify potentially suitable candidates for kidney transplantation.
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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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15
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Mateo R, Gupta S, Wallia A, Cameron C, Schmidt K, Oakes DJ, Aleppo G, Andrei AC, Wilcox JE, Grady K, Gordon R, Molitch ME. Relationship Between Hyperglycemia and Heart Transplant Rejection. Transplant Proc 2016; 47:2727-31. [PMID: 26680082 DOI: 10.1016/j.transproceed.2015.09.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/22/2015] [Accepted: 09/30/2015] [Indexed: 12/01/2022]
Abstract
PURPOSE Hyperglycemia increases risks of kidney and liver transplant rejection. To determine whether perioperative and subsequent glycemic control was associated with increased risk of heart transplant rejection over the year after transplantation, we performed a retrospective analysis of glycemic control and rejection rates in heart transplantation patients. METHODS Perioperative glucose levels were analyzed in 157 patients undergoing transplantation at Northwestern Memorial Hospital from June 2005 to December 2012 and compared in patients with and without rejection found on routine follow-up biopsy specimens. RESULTS Grade ≤1R rejection on biopsy was observed in 116 patients and grade ≥2R rejection (grade requiring increased anti-rejection treatment) in 41 patients. Although no significant differences in the preoperative fasting or inpatient mean glucose levels were found, the mean glucose levels from discharge to 1 year trended higher in those with grade ≥2R compared to grade ≤1R (128.8 ± 40.9 versus 142.2 ± 46.6 mg/dL, P = .084). In a multivariable logistic regression model, neither the lowest nor highest quartile of glucose levels had significantly different odds ratios (ORs) for the development of ≥2R compared to the middle 50% glucose levels. Older age (OR 0.96, P = .020) and higher body mass index levels (OR 0.86, P = .004) were significantly associated with lower odds of developing grade ≥2R. CONCLUSIONS Although the glucose trend regarding rejection was not statistically significant, we cannot exclude the possibility that much higher glucose levels would influence rejection rates.
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Affiliation(s)
- R Mateo
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S Gupta
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - A Wallia
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - C Cameron
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - K Schmidt
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - D J Oakes
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - G Aleppo
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - A-C Andrei
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - J E Wilcox
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - K Grady
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - R Gordon
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - M E Molitch
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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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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