Obesity following kidney transplantation and steroid avoidance immunosuppression

Abstract

Obesity is an important co-morbidity within end-stage renal disease (ESRD) and renal transplant populations. Previous studies have suggested that chronic corticosteroids result in increased body weight post-transplant. With the recent adoption of steroid-sparing immunosuppressive strategies, we evaluated the effect of these strategies on body mass index (BMI) after renal transplantation. We examined 95 renal transplant recipients enrolled in National Institutes of Health clinical transplant trials over the past three yr who received either lymphocyte depletion-based steroid sparing or traditional immunosuppressive therapy that included steroids for maintenance immunosuppression. Recipients were overweight prior to transplant and no significant differences existed in pre-transplant BMI among treatment groups. Regardless of therapy, BMI increased post-transplant in all recipients. The BMI increase consisted of an average weight gain of 5.01 +/- 7.12 kg (mean, SD) post-transplant. Additionally, in a number of recipients placed on maintenance steroids, subsequent withdrawal at a mean of 100 d post-transplant had no impact on weight gain. Thus, body weight and BMI increase following kidney transplantation, even in the absence of steroids. Thus, patients gain weight after renal transplantation regardless of the treatment strategy. Steroid avoidance alone does not reduce risk factors associated with obesity in our patient population.

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“…16 Immunosuppressive medicines such as steroid agents can result in increased appetites, affecting patient weight gain. 24 In a study conducted to identify the relation between steroid use and weight gain, weight gain occurred in 9% of patients who used steroids in the 36 months after transplant. Steroids affect appetite, resulting in increased weight gain.…”

Evolução do peso durante o primeiro ano de transplante renal e a ocorrência de Diabetes Mellitus após 5 anos de seguimento

“…1 , e, quando bem sucedido, proporciona melhor qualidade de vida em comparação com outros métodos dialíticos, contribuindo para o aumento da expectativa de vida e também beneficiando os pacientes nas esferas psicológica e emocional [2][3][4][5] . Esta modalidade de TRS apresenta números crescentes 6 .…”

Response to “Laparoscopic Sleeve Gastrectomy as a Weight Reduction Strategy in Obese Patients After Kidney Transplantation“

“…There are several mechanisms that could explain this phenomenon, including the effect of immunosuppressive agents and the diet change due to the cessation of dialysis treatment (3). As a result, many transplant patients become obese or their existing obesity worsens following transplantation.…”