Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis

Hill, Christopher J.; Courtney, Aisling E.; Cardwell, Christopher; Maxwell, Alexander P.; Lucarelli, Giuseppe; Veroux, Massimiliano; Furriel, F.; Cannon, Robert M.; Hoogeveen, Ellen K.; Doshi, Mona D.; McCaughan, Jennifer

doi:10.1093/ndt/gfv214

Cited by 161 publications

(130 citation statements)

References 55 publications

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“…In the same study, the meta‐analysis of studies using fully adjusted regression analysis (rather than an absolute risk ratio) demonstrated no association between obesity and mortality after kidney transplantation (HR 1.10; 95% CI 0.89‐1.15). This finding concurred with that of Hill et al, who used a similar methodology (HR 1.24; 95%CI 0.9‐1.7) . All of these reviews have suggested that factors associated with obesity, rather than obesity per se, that explain the differences between studies that have adjusted for potential confounders and those which have not.…”

Section: Obesity and Kidney Transplant Outcomessupporting

confidence: 83%

Obesity as a barrier to kidney transplantation: Time to eliminate the body weight bias?

MacLaughlin

Campbell

2019

Seminars in Dialysis

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There is clear evidence that survival rates following transplantation far exceed those for remaining on dialysis, regardless of body size measured by body mass index (BMI). Studies over the past 15 years also suggest little to no difference in long‐term outcomes, including graft survival and mortality, irrespective of BMI, in contrast to earlier evidence. However, weight bias still exists, as access to kidney transplantation remains inequitable in centers using arbitrary BMI limits. Clinicians faced with the decision regarding listing based on body size are not helped by conflicting recommendations in national and international guidelines. Therefore, in clinical practice, obesity, and recommendations for weight loss, remain a controversial issue when assessing suitability for kidney transplantation. Obesity management interventions in end‐stage kidney disease (ESKD), whether for weight loss for transplantation listing or for slowing kidney disease progression, are under‐explored in trial settings. Bariatric surgery is the most successful treatment for obesity, but carries increased risk in the ESKD population, and the desired outcome of kidney transplant listing is not guaranteed. Centers that limit transplants to those meeting arbitrary levels of body mass, rather than adopting an individualized assessment approach, may be unfairly depriving many ESKD patients of the survival and quality of life benefits derived from kidney transplantation. However, robotic kidney transplantation surgery holds promise for reducing perioperative risks related to obesity, and may therefore represent an opportunity to remove listing criteria based on size.

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Section: Obesity and Kidney Transplant Outcomessupporting

confidence: 83%

Obesity as a barrier to kidney transplantation: Time to eliminate the body weight bias?

MacLaughlin

Campbell

2019

Seminars in Dialysis

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“…These trends were observed in both the AD and LDs categories. Obese donor BMI has been shown to increase the risk of DGF, [15] while another study showed that there was little influence on transplant outcomes unless donor BMI was greater than 45 kg/m. 2 In our model, we adjusted for donor BMI and still found that recipient BMI had an independent impact on outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effect of the Obesity Epidemic on Kidney Transplantation: Obesity Is Independent of Diabetes as a Risk Factor for Adverse Renal Transplant Outcomes

et al. 2016

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BackgroundObesity is a growing epidemic in most developed countries including the United States resulting in an increased number of obese patients with end-stage renal disease. A previous study has shown that obese patients with end-stage renal disease have a survival benefit with transplantation compared with dialysis. However, due to serious comorbidities, many centers place restrictions on the selection of obese patients for transplantation. Further, due to obese patients having an increased risk of diabetes, it is unclear whether obesity can be an independent risk, independent of diabetes for increasing adverse renal transplant outcomes.MethodsTo investigate the role of obesity in kidney transplantation, we used the Scientific Registry of Transplant Recipients database. After filtering for subjects that had the full set of covariates including age, gender, graft type, ethnicity, diabetes, peripheral vascular disease, dialysis time and time period of transplantation for our analysis, 191,091 subjects were included in the analyses. Using multivariate logistic regression analyses adjusted for covariates we determined whether obesity is an independent risk factor for adverse outcomes such as delayed graft function, acute rejection, urine protein and graft failure. Cox regression modeling was used to determine hazard ratios of graft failure.ResultsUsing multivariate model analyses, we found that obese patients have significantly increased risk of adverse transplant outcomes, including delayed graft function, graft failure, urine protein and acute rejection. Cox regression modeling hazard ratios showed that obesity also increased risk of graft failure. Life-table survival curves showed that obesity may be a risk factor independent of diabetes mellitus for a shorter time to graft failure.ConclusionsA key observation in our study is that the risks for adverse outcome of obesity are progressive with increasing body mass index. Furthermore, pre-obese overweight recipients compared with normal weight recipients also had increased risks of adverse outcomes related to kidney transplantation.

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“…In terms of survival, obese patients tend to have no decrease in short-term survival but may have attenuated overall survival; however, whether this is related to a decrease in graft function or other obesity-related effects is undetermined (27,33). In terms of graft survival, acute rejection tends to be increased in obese patients (27,34,37), and obesity is associated with delayed graft function in kidney transplantation (29)(30)(31)(32), hepatocellular carcinoma in liver transplants (27,33), and grade III primary graft dysfunction in lung transplants (27).…”

Section: How Does Obesity Affect Solid Organ Transplantation?mentioning

confidence: 99%

Obesity-Associated Adipose Tissue Inflammation and Transplantation

Wu¹,

Dawson²,

Levings³

2016

American Journal of Transplantation

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Obesity is often associated with the development of adipose tissue (AT) inflammation, resulting in metabolic dysfunction and an increased risk for developing type 2 diabetes. It is also associated with multiple chronic diseases, including cardiovascular, liver, and kidney disease, and thus can contribute to organ failure. Several studies have investigated whether there is a correlation between obesity and outcomes in transplantation, but there is currently very limited information on the specific role of AT inflammation in the rejection process or on the overall function of the transplanted organ. Here, we provide a brief review of the current understanding of the cellular mechanisms that control obesity-associated AT inflammation and summarize knowledge about how obesity affects clinical outcomes following solid organ or hematopoietic stem cell transplantation. We also highlight opportunities for more research to better understand how obesity affects outcomes of transplantation.

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Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis

Abstract: Despite having a much higher likelihood of DGF, obese transplant recipients have only a slightly increased risk of graft loss and experience similar survival to recipients with normal BMI.

Cited by 161 publications

References 55 publications

Obesity as a barrier to kidney transplantation: Time to eliminate the body weight bias?

Obesity as a barrier to kidney transplantation: Time to eliminate the body weight bias?

Effect of the Obesity Epidemic on Kidney Transplantation: Obesity Is Independent of Diabetes as a Risk Factor for Adverse Renal Transplant Outcomes

Obesity-Associated Adipose Tissue Inflammation and Transplantation

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