Obesity and graft dysfunction among kidney transplant recipients: Increased risk for atherosclerosis

Abstract

Weight gain after kidney transplant is common, and may be related to graft dysfunction and high cardiovascular risk. We investigated the prevalence of obesity and evaluated the relationship between obesity and graft dysfunction in kidney transplant recipients (KTRs). All patients who received kidney transplant at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between January 2005 and December 2009 were recruited. Information on demographics, clinical characteristics and post-transplant care were documented. All patients underwent transthoracic echocardiography and carotid Doppler ultrasound for the assessment of cardiac status and carotid intima-media thickness (cIMT), respectively. Inferential and modelling statistics were applied. One hundred KTRs were recruited, of which 63 were males. The mean age was 42.2 ± 12.42 years with a range of 19-70 years. The mean body mass index and waist circumference of the recipients were 26.4 ± 4.81 kg/m2 and 90.73 ± 14.76 cm, respectively. Twenty-nine patients (29%) were obese; of these, 24 (82.8%) had moderate obesity, 4 (13.8%) had severe obesity, and 1 (3.4%) had morbid obesity. Graft dysfunction was present in 52%. Obese patients were older (P < 0.0001), had graft dysfunction (P = 0.03), higher mean arterial blood pressure (P = 0.022), total cholesterol (P = 0.019), triglycerides (P < 0.0001), left ventricular mass index (P = 0.035) and cIMT (P = 0.036). Logistic regression showed obesity to be independently associated with graft dysfunction (P = 0.033). Obesity after kidney transplantation is common and is associated with graft dysfunction and markers of atherosclerosis.

Weight gain after renal transplant: Incidence, risk factors, and outcomes

“…Acknowledging the limitation of the small number of patients and length of the follow-up, we did not notice significant differences in those parameters. In contrast, Aminu et al have reported that obese patients post-renal transplantation were more prone to graft dysfunction and progression of atherosclerosis, including higher mean arterial blood pressure, total cholesterol, triglycerides, left ventricular mass index, and higher carotid intima-media thickness [ 24 ]. This could be explained by the fact that the mean duration of follow-up in the Aminu et al study was 60 ± 18.8 (range 36–89) months while it was 12 months in our study.…”

Nutrition Disturbances and Metabolic Complications in Kidney Transplant Recipients: Etiology, Methods of Assessment and Prevention—A Review

“…KTx recipients represent a whole spectrum of undernutrition and obesity. While a higher BMI is rarely related to adverse outcomes in HD patients [ 12 ], it appears disadvantageous in KTx patients [ 13 ]. In the perioperative period, obesity is associated with poor wound healing, prolonged hospitalization, and surgical complications including lymphoceles and delayed graft function [ 14 ].…”

“…In the perioperative period, obesity is associated with poor wound healing, prolonged hospitalization, and surgical complications including lymphoceles and delayed graft function [ 14 ]. In the late post-transplant period, obese individuals are more prone to impaired graft function, the presence of proteinuria, PTDM, and atherosclerosis progression, which lead to hypertension and CV complications [ 13 ]. The largest increase in body mass occurs within the first 12 months following transplantation [ 15 ].…”