Early Postoperative Complications and Outcomes of Kidney Transplantation in Moderately Obese Patients

Association between Pre-operative Body Mass Index and Surgical Infection in Perihilar Cholangiocarcinoma Patients Treated with Curative Resection: A Multi-center Study

Background: The objective of this study was to investigate the association between pre-operative body mass index (BMI) and surgical infection in perihilar cholangiocarcinoma (pCCA) patients treated with curative resection. Methods: Consecutive pCCA patients were enrolled from four tertiary hospitals between 2008 and 2022. According to pre-operative BMI, the patients were divided into three groups: low BMI (≤18.4 kg/m2), normal BMI (18.5-24.9 kg/m2), and high BMI (≥25.0 kg/m2). The incidence of surgical infection among the three groups was compared. Multivariable logistic regression models were used to determine the independent risk factors associated with surgical infection. Results: A total of 371 patients were enrolled, including 283 patients (76.3%) in the normal BMI group, 30 patients (8.1%) in the low BMI group, and 58 patients (15.6%) in the high BMI group. The incidence of surgical infection was significantly higher in the patients in the low BMI and high BMI groups than in the normal BMI group. The multivariable logistic regression model showed that low BMI and high BMI were independently associated with the occurrence of surgical infection. Conclusions: The pCCA patients with a normal BMI treated with curative resection could have a lower risk of surgical infection than pCCA patients with an abnormal BMI.

Impact of Obesity on Postoperative Complications after Lateral Skull Base Surgery: A Systematic Review

INTRODUCTION

The relationship between obesity and complications after lateral skull base tumor resection is not clear. There is conflicting evidence regarding the incidence of postoperative complications in this patient population. The purpose of this study is to examine the relationship between obesity and outcomes following lateral skull base tumor resection.

DATA SOURCES

Data were extracted from PubMed, Embase, CINAHL, and Cochrane CENTRAL.

METHODS

Included studies assessed the relationship between obesity and outcomes following lateral skull base tumor removal. Studies with ≤5 patients, pediatric patients, duplicate patient populations, or insufficient data were excluded. Two independent investigators reviewed each study for inclusion. A third reviewer served as a tie-breaker for any conflicts. Extracted data includes patient demographics, tumor pathology, surgical approach, and postoperative outcomes including incidence of cerebrospinal fluid (CSF) leak and other postoperative complications, length of stay (LOS), and readmission and reoperation rates. Descriptive statistics were used to compare postoperative outcomes for obese and nonobese controls.

RESULTS

14 studies met final inclusion criteria. Nine studies evaluated the relationship between obesity and CSF leaks. Four studies found a significant increase in postoperative CSF leak in obese patients compared to nonobese controls. The remaining studies trended toward an increased incidence of CSF leak in the obese population but did not reach statistical significance. One out of seven studies found that obesity increased postoperative LOS, and one out of five studies found that obesity increased reoperation rates following tumor resection.

CONCLUSIONS

Based on the results, obesity does not appear to increase LOS, readmission, or reoperation rates after lateral skull base tumor resection. The relationship between obesity and postoperative CSF leak, however, warrants further analysis.

Factores de riesgo para el desarrollo de complicaciones de la herida quirúrgica en el trasplante renal

Introducción: Las complicaciones quirúrgicas suponen un riesgo para el paciente tras el trasplante renal, siendo diversos los posibles factores de riesgo implicados.Objetivo: Determinar qué factores de riesgo contribuyen a la aparición de complicaciones de la herida quirúrgica en pacientes sometidos a un trasplante renal.Material y Método: Estudio de cohorte retrospectivo en pacientes trasplantados renales desde enero 2018 a diciembre 2021. Se recogieron datos sociodemográficos y clínicos del donante y del receptor. Se analizó la incidencia de infección y dehiscencia de la herida quirúrgica y sus factores de riesgo.Resultados: Presentaron infección el 13,5% de los pacientes y dehiscencia el 15,9% de la muestra, siendo pacientes con más edad (61,71±9,81 años frente a 56,56±11,88 años; p=0,030), con mayor tasa de sobrepeso según su IMC (42,9% frente 19,6%; p=0,046) y una mayor comorbilidad asociada (3,07±1,54 frente a 2,23±1,38 puntos; p=0,003). De los pacientes con infección, el 53,6% presentó, además, dehiscencia superficial de la herida. El exudado apareció en el 90,9% de los casos que desarrollaron una dehiscencia frente al 12,1% de los pacientes que no sufrieron dicha complicación (p<0,001).Conclusiones: La infección y la dehiscencia son complicaciones frecuentes tras el TR. La edad, el sobrepeso, comorbilidad alta y el exudado son factores de riesgo para desarrollar complicaciones de la herida quirúrgica tras el trasplante renal.

Management of obesity in kidney transplant candidates and recipients: A clinical practice guideline by the Descartes working group of ERA

The clinical practice guideline Management of Obesity in Kidney Transplant Candidates and Recipients was developed to guide decision-making in caring for people with end-stage kidney disease (ESKD) living with obesity. The document considers the challenges in defining obesity, weighs interventions for treating obesity in kidney transplant candidates as well as recipients and reflects on the impact of obesity on the likelihood of wait-listing as well as its effect on transplant outcomes. It was designed to inform management decisions related to this topic and provide the backdrop for shared decision-making. This guideline was developed by the European Renal Association’s Developing Education Science and Care for Renal Transplantation in European States working group. The group was supplemented with selected methodologists to supervise the project and provide methodological expertise in guideline development throughout the process. The guideline targets any healthcare professional treating or caring for people with ESKD being considered for kidney transplantation or having received a donor kidney. This includes nephrologists, transplant physicians, transplant surgeons, general practitioners, dialysis and transplant nurses. Development of this guideline followed an explicit process of evidence review. Treatment approaches and guideline recommendations are based on systematic reviews of relevant studies and appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation approach. Limitations of the evidence are discussed and areas of future research are presented.

Obesity Management in Kidney Transplant Candidates: Current Paradigms and Gaps in Knowledge

In this review, we discuss the increasing prevalence of obesity among people with chronic and end-stage kidney disease (ESKD) and implications for kidney transplant (KT) candidate selection and management. Although people with obesity and ESKD receive survival and quality-of-life benefits from KT, most KT programs maintain strict body mass index (BMI) cutoffs to determine transplant eligibility. However, BMI does not distinguish between visceral adiposity, which confers higher cardiovascular risks and risks of perioperative and adverse posttransplant outcomes, and muscle mass, which is protective in ESKD. Furthermore, requirements for patients with obesity to lose weight before KT should be balanced with the findings of numerous studies that show weight loss is a risk factor for death among patients with ESKD, independent of starting BMI. Data suggest that KT is associated with survival benefits relative to remaining on dialysis for candidates with obesity although recipients without obesity have higher delayed graft function rates and longer transplant hospitalization durations. Research is needed to determine the optimal body composition metrics for KT candidacy assessments and risk stratification. In addition, ESKD-specific obesity management guidelines are needed that will address the neurologic, behavioral, socioeconomic, and physical underpinnings of this increasingly common disease.

Nursing Care for Kidney Transplant Patients: A Scoping Review

Objectives: Mapping nursing care in kidney transplant patients. Materials and method: A scoping review was conducted according to the recommendations of the Joanna Briggs Institute Reviewers’ Manual. Data were collected through 13 national and international databases from December 2020 to January 2021, following scientific rigor in the selection of the material. The pre-selection was made by reading the title, abstract and introductory text in advance; the materials included in this stage were read in full to define the content for the study. Results: Fifteen studies were included. Of these, 60% are articles; dissertations, manuals, protocols, guidelines and bulletins totaled 40% of the material studied. 86.6% of the material has a quantitative approach. Regarding the methodological design, 73.3% were descriptive/transversal character studies. Regarding the mapping of nursing care, it was possible to divide them into two categories: nursing care after kidney transplantation (immediate, mediated and late) and nursing care after kidney transplantation in primary health/extra-hospital care. Conclusions: It is concluded that the study allowed mapping nursing care to kidney transplant patients in the immediate, late and primary health care periods.