Donor obesity and weight gain after transplantation: two still overlooked threats to long-term graft survival

Abstract

The effect of donor obesity on kidney transplantation success has long been an overlooked clinical research area. Even though there is no strict guideline in most countries prohibiting donation from obese individuals, most candidates with BMI over 35-40 kg/m2 are overturned due to concerns regarding the renal functional deterioration in the donor over the long run. The effects of excessive fat mass on renal function and allograft survival have been analyzed by several longitudinal and follow-up studies. These studies have documented the deleterious effect of long term graft outcomes by excessive body mass in living kidney donors and de novo obesity or pre-existing obesity worsening post transplantation on kidney outcomes. However, there is a paucity of clinical trials aimed at countering overweight and obesity in living or deceased kidney donors and in transplant patients. In this review, we will briefly review mechanism whereby fat excess may induce adverse kidney outcomes to then describe the effect on graft function and survival by living obese donors along with the effect post transplantation obesity on the same outcomes.

Fatores de risco para menor compensação renal pós-nefrectomia: análise de doadores de rim vivo em uma coorte amazônica

“…Em nosso estudo foi possível observar a obesidade como fator de risco para menor compensação renal. Embora não haja uma diretriz rígida na maioria dos países que proíba a doação de indivíduos obesos, a maior parte dos candidatos com IMC > 35-40 kg/m 2 é rejeitada devido a preocupações com a deterioração da função renal em longo prazo 33 . De acordo com a ABTO, pessoas com IMC > 35 kg/m 2 não devem ser aceitas como doadoras no Brasil e pessoas com IMC entre 30 e 35 kg/m 2 devem ser avaliadas individualmente e aconselhadas a mudar seu estilo de vida 30 .…”

“…De acordo com a ABTO, pessoas com IMC > 35 kg/m 2 não devem ser aceitas como doadoras no Brasil e pessoas com IMC entre 30 e 35 kg/m 2 devem ser avaliadas individualmente e aconselhadas a mudar seu estilo de vida 30 . De fato, a obesidade tem impacto sobre a saúde renal por diversos mecanismos, dentre eles a glomerulopatia relacionada à obesidade, além de predispor ao desenvolvimento de DRC 33 .…”

Risk factors for lower renal compensation after nephrectomy: an analysis of living kidney donors in an Amazonian cohort

“…In our study, obesity was a risk factor for lower renal compensation. Although there is no strict guideline in most countries prohibiting donors with these conditions, most candidates with a BMI > 35-40 kg/m 2 are rejected due to concerns about long-term deterioration of kidney function 33 . According to the ABTO, individuals with a BMI > 35 kg/m 2 must not be accepted as donors in Brazil and individuals with a BMI between 30 and 35 kg/m2 must be individually evaluated and advised to implement lifestyle changes 30 .…”

“…According to the ABTO, individuals with a BMI > 35 kg/m 2 must not be accepted as donors in Brazil and individuals with a BMI between 30 and 35 kg/m2 must be individually evaluated and advised to implement lifestyle changes 30 . In fact, obesity impacts kidney health through several mechanisms, including obesityrelated glomerulopathy, and has been associated with the development of CKD 33 .…”

“…Studies with long-term donor follow-up demonstrated that obese donors faced a greater decline in GFR, in addition to a higher incidence of diabetes mellitus and hypertension 33 , 34 . Other authors described a higher risk of end-stage renal disease in obese donors 35 .…”