Morbid obesity and functional status as predictors of surgical complication after renal transplantation

Veasey, Tara; Fleming, James N.; Strout, Sara; Miller, Ryan; Pilch, Nicole A.; Meadows, Holly B.; Mardis, Caitlin R.; Mardis, B. Andrew; Shenvi, Sunil D.; McGillicuddy, John W.; Chavin, Kenneth D.; Baliga, Prabhakar K.; Taber, David J.

doi:10.1016/j.amjsurg.2017.05.009

Cited by 15 publications

(9 citation statements)

References 21 publications

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“…Surgery in patients with larger body habitus frequently have increased operative and anesthesia times. 22 At our institution, the senior author generally performs a Gibson incision from the symphysis pubis laterally, extending superomedial to the anterior superior iliac spine. The retroperitoneum is accessed lateral to the rectus sheath and the iliac vessels are exposed.…”

Section: Discussionmentioning

confidence: 99%

Safety and utility of panniculectomy in renal transplant candidates and end stage renal disease patients

Laspro,

Stead,

Barrow

et al. 2024

Clinical Transplantation

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BackgroundAs the obesity crisis in the United States continues, some renal transplantation centers have liberalized their BMI criteria necessary for transplant eligibility. More individuals with larger body‐habitus related comorbidities with End‐Stage Renal Disease (ESRD) now qualify for renal transplantation (RT). Surgical modalities from other fields also interact with this patient population.MethodsIn order to assess surgical outcomes of panniculectomy in the context of renal transplantation and ESRD, the authors performed a systematic review following the Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) 2020 guidelines. Due to a paucity of existing primary studies, we retrospectively collected data on patients with ESRD undergoing panniculectomy from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) to evaluate outcomes of body contouring in this patient population.ResultsFrom the systematic review, a total of 783 ESRD patients underwent panniculectomy among the studies identified. Of these, 91 patients underwent panniculectomy simultaneously to RT while 692 had their pannus resected prior to kidney transplant. The most common complication was hematoma followed by wound dehiscence. From the NSQIP database, 24 868 patients met the inclusion criteria for analysis. In the setting of renal transplant status, patients with diabetes, hypertension requiring medication, and requiring dialysis were more likely to suffer postoperative complications (OR 1.31, 1.15, and 2.2, respectively). However, upon sub‐analysis of specific types of complications, the only retained association was between diabetes and wound complication.ConclusionPreliminary data show that panniculectomy in ESRD patients appears to be safe, though with a nominal increased risk for complications. Pannus resection does not appear to impact post‐transplantation outcomes, including long‐term allograft survival. Larger, higher powered, randomized studies are needed to confirm the safety, utility, and medical benefit of panniculectomy in the context of renal transplantation.

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Section: Discussionmentioning

confidence: 99%

Safety and utility of panniculectomy in renal transplant candidates and end stage renal disease patients

Laspro,

Stead,

Barrow

et al. 2024

Clinical Transplantation

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“…Studies have demonstrated poor clinical outcomes after kidney transplant among patients with impaired functional status including reduced patient and allograft survival [ 1 , 5 , 7 , 8 , 15 , 16 , 17 ]. As a result, in combination with limited transplant resources, kidney transplant surgeries are uncommonly performed for kidney transplant recipients with severely limited functional status [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…While patients with a low functional status have a higher risk of post-operative complications and death following kidney transplant as compared to those with higher physical functioning scores, this risk is likely still less than remaining on dialysis [ 1 , 11 , 15 ]. Furthermore, kidney transplant patients, including recipients with low functional status, are likely heterogenous, and there are many factors, including recipient, donor, and transplant-related variables, that can result in varying outcomes contrary to what has historically been reported in the literature [ 11 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Distinct Phenotypes of Kidney Transplant Recipients in the United States with Limited Functional Status as Identified through Machine Learning Consensus Clustering

Jadlowiec

Kaewput

Vaitla

et al. 2022

JPM

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Background: There have been concerns regarding increased perioperative mortality, length of hospital stay, and rates of graft loss in kidney transplant recipients with functional limitations. The application of machine learning consensus clustering approach may provide a novel understanding of unique phenotypes of functionally limited kidney transplant recipients with distinct outcomes in order to identify strategies to improve outcomes. Methods: Consensus cluster analysis was performed based on recipient-, donor-, and transplant-related characteristics in 3205 functionally limited kidney transplant recipients (Karnofsky Performance Scale (KPS) < 40% at transplant) in the OPTN/UNOS database from 2010 to 2019. Each cluster’s key characteristics were identified using the standardized mean difference. Posttransplant outcomes, including death-censored graft failure, patient death, and acute allograft rejection were compared among the clusters Results: Consensus cluster analysis identified two distinct clusters that best represented the clinical characteristics of kidney transplant recipients with limited functional status prior to transplant. Cluster 1 patients were older in age and were more likely to receive deceased donor kidney transplant with a higher number of HLA mismatches. In contrast, cluster 2 patients were younger, had shorter dialysis duration, were more likely to be retransplants, and were more likely to receive living donor kidney transplants from HLA mismatched donors. As such, cluster 2 recipients had a higher PRA, less cold ischemia time, and lower proportion of machine-perfused kidneys. Despite having a low KPS, 5-year patient survival was 79.1 and 83.9% for clusters 1 and 2; 5-year death-censored graft survival was 86.9 and 91.9%. Cluster 1 had lower death-censored graft survival and patient survival but higher acute rejection, compared to cluster 2. Conclusion: Our study used an unsupervised machine learning approach to characterize kidney transplant recipients with limited functional status into two clinically distinct clusters with differing posttransplant outcomes.

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“…Some specific obese subgroup patients such as afro-american with BMI >40kg/m 2 may not benefit from transplantation (8,9). Indeed, surgical complications and delayed graft function rate have been shown to be higher in obese patients (10), despite several other studies finding no survival difference between obese and non obese kidney graft recipients (9) (11).…”

Section: Introductionmentioning

confidence: 99%

Is recipient's body mass index a determinant of short term complications in early renal transplantation?

Queruel

Kaboré

Guillaume

et al. 2020

Progrès en Urologie

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Morbid obesity and functional status as predictors of surgical complication after renal transplantation

Cited by 15 publications

References 21 publications

Safety and utility of panniculectomy in renal transplant candidates and end stage renal disease patients

Safety and utility of panniculectomy in renal transplant candidates and end stage renal disease patients

Distinct Phenotypes of Kidney Transplant Recipients in the United States with Limited Functional Status as Identified through Machine Learning Consensus Clustering

Is recipient's body mass index a determinant of short term complications in early renal transplantation?

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