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Choffel L, Kleinclauss F, Balssa L, Barkatz J, Lecheneaut M, Guichard G, Frontczak A. Surgical complications and graft survival in kidney transplant recipients according to CT-scans evaluation. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102543. [PMID: 37858380 DOI: 10.1016/j.purol.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/24/2023] [Accepted: 09/28/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Obesity is a risk factor for significant surgical complications following kidney transplantation. We examined morphometric parameters other than the body mass index (BMI) that could predict surgical complications and determine their impact on graft survival. MATERIALS Kidney transplantations performed at our center between 2012 and 2019 were retrospectively evaluated. Data for visceral adipose tissue (VAT), subcutaneous adipose tissue, psoas surface, abdominal perimeter (AP), and vessel-to-skin distance (VSK) were collected from pre-transplant computed tomography (CT) scans. The primary outcome was the occurrence of surgical complications within 1 year of transplantation; the secondary outcome was graft survival. RESULTS We included 321 (88%) of 364 kidney transplant recipients, of which 154 (46.5%) patients experienced some form of surgical complication in the 1st year of follow-up. Univariate analysis revealed that higher VAT (P=0.004), VSK (P=0.007), and AP (P=0.01) values were potential risk factors for early postoperative morbidity. However, none of these factors were significant in the multivariate analysis. Concerning the secondary outcome, while the univariate analysis identified higher VAT (P=0.001) value as a risk factor, in the multivariate analysis only delayed graft function demonstrated a significant impact on graft survival (P=0.002). CONCLUSIONS Although morphological parameters showed greater accuracy in predicting surgical complications in univariate analysis, these results were not significant in multivariate analysis. Moreover, these factors were not significantly associated with graft survival. Therefore, routine application of analyses based on these parameters, regardless of BMI, may not be useful. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- L Choffel
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France.
| | - F Kleinclauss
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France; University of Franche-Comté, 25000 Besançon, France
| | - L Balssa
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France
| | - J Barkatz
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France
| | - M Lecheneaut
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France
| | - G Guichard
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France
| | - A Frontczak
- Department of Urology, Andrology and Renal Transplantation, University Hospital of Besançon, 3, boulevard A-Fleming, 25030 Besançon, France; University of Franche-Comté, 25000 Besançon, France
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Pinar U, Mageau A, Renard Y, Rod X, Lebacle C, Barrou B, Zaidan M, Irani J, Bessede T. Pre-transplant morphometry by computed tomography scan and post-transplant dialysis risk in overweight or obese kidney transplant recipients. Int Urol Nephrol 2021; 53:2469-2475. [PMID: 34536192 DOI: 10.1007/s11255-021-02995-4] [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: 04/19/2021] [Accepted: 09/12/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Adipose distribution and sarcopenia could better assess kidney transplantation outcomes than body mass index (BMI) and have been poorly evaluated among obese and overweight recipients. We aimed to evaluate morphometric radiologic markers to predict post-operative dialysis within this population. METHODS We conducted a retrospective study including patients with a BMI > 25 kg/m2 undergoing kidney transplantation during 5 years. Subcutaneous adipose tissue surface (SAT), visceral adipose tissue surface (VAT), and psoas surface were measured on CT scans sections. A model predictive of post-transplantation dialysis was elaborated through a multivariable logistic regression and was compared to a model including only BMI. RESULTS Overall, 248 patients were included whom mean (SD) BMI and age were, respectively, 29.7 kg/m2 (3.6) and 56 years (12.7). Of them, 83 (33.5%) needed dialysis: 14 (5.7%) for primary kidney failure and 69 (27.8%) for delayed kidney function. On multivariable analysis, SAT, VAT and deceased donor were significantly associated with post-operative dialysis (respectively, OR [95%CI]:1.6 [1.1-2.6], 1.6[1.1-2.6], and 7.5 [1.6-56]). The area under the curve of this predictive model was 0.70 versus 0.64 for a BMI-based model. CONCLUSION High VAT and SAT were associated with post-transplantation dialysis. A predictive model based on these morphometrics could provide a better appreciation of graft recovery after transplantation among obese and overweight recipients. External validation is needed.
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Affiliation(s)
- Ugo Pinar
- Department of Urology and Transplantation Surgery, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, 78 rue du général Leclerc, Le Kremlin-Bicêtre, 94270, Paris, France.
| | - Arthur Mageau
- Department of Internal Medicine, Hôpital Henri Mondor, AP-HP, Université Paris Saclay, Créteil, 94010, Paris, France
| | - Yohann Renard
- Department of Visceral Surgery, Reims, Champagne-Ardenne University, Robert Debré University Hospital, Reims, France
| | - Xavier Rod
- Department of Urology and Kidney Transplantation, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, AP-HP. Sorbonne Université, 75013, Paris, France
| | - Cédric Lebacle
- Department of Urology and Transplantation Surgery, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, 78 rue du général Leclerc, Le Kremlin-Bicêtre, 94270, Paris, France
| | - Benoit Barrou
- Department of Urology and Kidney Transplantation, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, AP-HP. Sorbonne Université, 75013, Paris, France
| | - Mohamad Zaidan
- Department of Nephrology, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, 94270, Paris, France
| | - Jacques Irani
- Department of Urology and Transplantation Surgery, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, 78 rue du général Leclerc, Le Kremlin-Bicêtre, 94270, Paris, France
| | - Thomas Bessede
- Department of Urology and Transplantation Surgery, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, 78 rue du général Leclerc, Le Kremlin-Bicêtre, 94270, Paris, France.,U1195, Université Paris-Saclay, Inserm, Le Kremlin-Bicêtre, 94276, Paris, France
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Pinar U, Rod X, Mageau A, Renard Y, Lebacle C, Barrou B, Drouin S, Irani J, Bessede T. Surgical complications risk in obese and overweight recipients for kidney transplantation: a predictive morphometric model based on sarcopenia and vessel-to-skin distance. World J Urol 2020; 39:2223-2230. [PMID: 32785765 DOI: 10.1007/s00345-020-03407-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Sarcopenia or adipose tissue distribution within obese and overweight renal transplanted have been poorly evaluated. Our objective was to evaluate morphometric markers to predict surgical complications in kidney transplantation. METHODS We retrospectively included patients with a BMI > 25 kg/m2 undergoing kidney transplantation from 2012 to 2017. Following measurements were performed on CT-scan sections: Sub-cutaneous Adipose Tissue surface (SAT), Visceral Adipose Tissue surface (VAT), Vessel-to-Skin distance (VSK), Abdominal Perimeter (AP), and Psoas surface. A multivariable logistic regression model with BMI was compared to a model containing morphometric variables to determine the best predictive model for surgical complications. RESULTS 248 patients were included, 15 (6%) experienced transplant nephrectomy, 18 (7.3%) urinary leakage, and 29 (11.7%) subcapsular renal hematoma. Multivariable logistic regression evidenced that sarcopenia and VSK were risk factors of surgical complication within a year post-transplantation (respectively, OR = 0.9, 95%CI (0.8-0.9), p = 0.04 and OR = 1.2, 95%CI (1.1-1.3), p = 0.002). Area under the curve for a predictive model including VSK, age and psoas surface was 0.69, whereas BMI model was 0.65. CONCLUSION Combined morphometric parameters of obesity were associated with surgical complications in kidney transplantation. Morphometric threshold may provide a more accurate and objective criteria than BMI to evaluate kidney transplantation outcomes. External validation is needed.
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Affiliation(s)
- Ugo Pinar
- Department of Urology, Hôpital de Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin-Bicêtre, 94270, France.
- Department of Urology and Transplantation Surgery, Hôpital Bicêtre, AP-HP. Université Paris Saclay, 78 rue du général Leclerc, Le Kremlin-Bicêtre, 94270, France.
| | - Xavier Rod
- Department of Urology and Renal Transplantation, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, AP-HP. Sorbonne Université, Paris, 75013, France
| | - Arthur Mageau
- Department of Internal Medicine, Hôpital Henri Mondor, AP-HP, Université Paris Saclay, Créteil, 94010, France
| | - Yohann Renard
- Department of Visceral Surgery, Reims, Champagne-Ardenne University, Robert Debré University Hospital, Reims, France
| | - Cedric Lebacle
- Department of Urology, Hôpital de Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin-Bicêtre, 94270, France
| | - Benoit Barrou
- Department of Urology and Renal Transplantation, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, AP-HP. Sorbonne Université, Paris, 75013, France
| | - Sarah Drouin
- Department of Urology and Renal Transplantation, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, AP-HP. Sorbonne Université, Paris, 75013, France
| | - Jacques Irani
- Department of Urology, Hôpital de Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin-Bicêtre, 94270, France
| | - Thomas Bessede
- Department of Urology, Hôpital de Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin-Bicêtre, 94270, France
- U1195, Université Paris-Saclay, Inserm, Le Kremlin-Bicêtre, 94276, France
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