One-Year Outcomes of a Cohort of Renal Transplant Patients Related to BMI in a Steroid-Sparing Regimen

Abstract

BackgroundThe prevalence of overweight and obese kidney transplant recipients (KTR) has risen in parallel to the obesity epidemic that has affected the general population over the last two decades. At present, there is an ongoing debate regarding the suitability for transplantation of obese patients.MethodsData were prospectively collected on consecutive single organ KTR transplanted between January 2014 and March 2016. The patients were stratified according to their body mass index (BMI) using the World Health Organization classification. As a measure of allograft function Modification of Diet in Renal Disease, estimated glomerular filtration rate was used at 3, 6, and 12 months posttransplant.ResultsWe included 370 KTR: 126 of 370 women; median age, 52.7 years (range, 19-77 years), followed up for a median of 19.5 ± 8.6 months. In total, 155 (41.9%) KTR were underweight or of normal BMI at transplant, whereas 148 (40%) were overweight, and 67 (18.1%) were classified as obese (47 [12.7%] class 1, 11 [3%] class 2, 9 [2.4%] class 3). Overweight and obese KTR had a higher incidence of pretransplant diabetes (P = 0.021), but no difference was found in new-onset hyperglycemia posttransplant (P = 0.35). There was also no difference in posttransplant hospital length of stay (P = 0.386). Obese and overweight KTR had a significantly lower estimated glomerular filtration rate than underweight and normal BMI KTR at 3 and 6 months posttransplant, a finding that did not persist at 1 year follow-up. Overall, 23 patients lost their grafts, and 20 patients died during follow-up. Kaplan Meier analysis showed no difference in allograft loss between the different BMI groups (log rank P = 0.7).ConclusionsIn this single-center study, which used short-term data, overweight and obese patients were shown not to have inferior outcomes regarding renal function 1 year posttransplant.

Obesity: An Independent Predictor of Morbidity and Graft Loss after Kidney Transplantation

“…Our findings are in contrast with some recent studies. Bellini et al [21] looked into pretransplant BMI and its effect on graft outcomes at 1 year and found that obese patients were shown not to have inferior graft outcomes at 1 year after transplant. However, this study had only 67 patients with early steroid withdrawal, and the patients were followed only for 1 year [21].…”

“…Bellini et al [21] looked into pretransplant BMI and its effect on graft outcomes at 1 year and found that obese patients were shown not to have inferior graft outcomes at 1 year after transplant. However, this study had only 67 patients with early steroid withdrawal, and the patients were followed only for 1 year [21]. Similarly, Pieloc et al [22] found that morbid obesity was not independently associated with graft failure or patient mortality by looking at the UNOS data; however, this study excluded patients with BMI >40 kg/m 2 .…”

Obesity and bariatric intervention in patients with chronic renal disease

“…Another study also showed no difference in terms of NODAT or allograft loss, although overweight and obese patients had a lower eGFR at 3 and 6 months after transplantation. 54 Because obesity is associated with an increased risk of steroid-induced diabetes and CVD risk factors, 55 our centre’s policy is to withdraw steroids early (within the first week post-transplantation), which might contribute to amelioration of these poor outcomes in patients with a high BMI. 54…”

The Conundrum of High Body Mass Index in Kidney Transplant Patients

“…Kidney transplant in the high BMI recipient is often associated with wound infection and dehiscence, lymphocele, hematoma, renal artery stenosis, renal vein thrombosis, acute rejection and delayed graft function [10,11]. This higher surgical risk could translate into an overall longer hospital stay, although not always significant in high volume centres [12].…”

“…The immunosuppressive therapy plays a major role in the post-transplant obese population to prevent the rejection/graft loss and to avoid the detrimental metabolic side effects. As obesity is associated with an increased risk of steroid induced diabetes and CVD risk factors [28], our centre policy is to withdraw them early, within the first week post-transplant [12]. Alternative new drugs as belatacept with better metabolic risk profile look promising in order to reduce drug-induced toxicities, such as hypertension and diabetes [29], with the potential of improving long-term renal function.…”