Impact of obesity in kidney transplantation: a prospective cohort study from French registries between 2008 and 2014

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.

The Impact and Effectiveness of Weight Loss on Kidney Transplant Outcomes: A Narrative Review

“…It is noteworthy that a higher graft survival was also found in patients with obesity who lost more than 10% weight compared to patients with obesity and without weight loss. However, that research did not find a relationship between obesity or weight loss with mortality after transplantation [39].…”

The Impact of Obesity and Associated Comorbidities on the Outcomes after Renal Transplantation with a Living Donor vs. Deceased Donor Grafts

“…The patient survival in patients with a high BMI was associated with significantly increased mortality in both subgroups of graft sources (LD, p = 0.045; DD p = 0.004). However, in a prospective cohort study from French registries they presented a lower graft survival but similar patient survival in patients with grade 1 obesity [ 25 ].…”

Abdominal Organ Transplantation: Noteworthy Literature in 2022

“…Obesity among KTx recipients and its association with graft outcomes was another area of study. Obesity was associated with decreased graft survival, more DGF, increased postoperative surgical complications, [24][25][26] longer procedure duration, and longer warm ischemia time. 27 Tsapepas et al found that body mass index (BMI) ≥35 was associated with increased surgical site infections on multivariable analysis (adjusted OR 3.34; 95% CI 1.55-7.22; P = .022), though this study did not find the increased rate of graft failure in obese patients that was found in prior studies.…”

“…However, there was a confounding variable, as the weight loss group also had an increased duration of dialysis compared to the group that did not lose weight. 24 Finally, Jarrar et al found through a retrospective cohort study of over 200 000 transplants that donor obesity in combination with recipient obesity further increases the risk for graft loss and DGF over recipient obesity alone. 29 These findings all point to an increased risk of negative outcomes seen in renal transplantation in the setting of obesity.…”