Renal transplantation outcomes in obese patients: a French cohort-based study

Foucher, Yohann; Lorent, Marine; Albano, Laetitia; Roux, Sandrine; Pernin, Vincent; Quintrec, Moglie Le; Legendre, Christophe; Buron, Fanny; Morélon, Emmanuel; Girerd, Sophie; Ladrière, Marc; Glotz, Denis; Lefaucher, Carmen; Kerleau, Clarisse; Dantal, Jacques; Branchereau, J.; Giral, Magali

doi:10.1186/s12882-021-02278-1

Cited by 18 publications

(16 citation statements)

References 31 publications

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“…In a retrospective single-center study of 1,132 kidney transplant recipients, Weissenbacher et al also showed that recipient BMI correlates with the incidence of DGF after deceased donor KT (recipient BMI: OR 1.087; 95% CI, 1.043–1.132; P < 0.0001) [ 34 ]. Additionally, a previously published retrospective multi-center study by Foucher et al including 3,071 non-obese (BMI < 30) and 615 obese (BMI ≥ 30) recipients of kidney transplants confirmed this observation (recipient BMI: OR 1.89; 95% CI, 1.56–2.29; P < 0.0001) [ 33 ].…”

Section: Discussionmentioning

confidence: 66%

“…Despite a higher rate of major postoperative complications, no post-operative deaths occurred in the group with obese kidney grafts recipients within the first three months after KT in our study cohort. Especially cardiovascular risk factors must be excluded prior to KT, as fatal cardiac events are a common cause of morbidity and death after KT in obese recipients [ 30 – 33 ]. Therefore, in our department, all patients routinely receive a cardiac stress test and, if necessary, a cardiac catheterization before enlisting for KT.…”

Section: Discussionmentioning

confidence: 99%

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Recipient obesity as a risk factor in kidney transplantation

et al. 2022

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Background The aim of the study was to investigate the effect of recipient obesity on the short- and long-term outcomes of patients undergoing primary kidney transplantation (KT). Patients and methods A total of 578 patients receiving primary KT in our department between 1993 and 2017 were included in the study. Patients were divided according to their body mass index (BMI) into normal weight (BMI 18.5–24.9 kg/m2; N = 304), overweight (BMI 25–29.9 kg/m2; N = 205) and obese (BMI ≥ 30 kg/m2; N = 69) groups. Their clinicopathological characteristics, outcomes, and survival rates were analyzed retrospectively. Results Obesity was associated with an increased rate of surgical complications such as wound infection (P < 0.001), fascial dehiscence (P = 0.023), and lymphoceles (P = 0.010). Furthermore, the hospital stay duration was significantly longer in the groups with obese patients compared to normal weight and overweight patients (normal weight: 22 days, overweight: 25 days, and obese: 33 days, respectively; P < 0.001). Multivariate analysis showed that recipient obesity (BMI ≥ 30) was an independent prognostic factor for delayed graft function (DGF) (OR 2.400; 95% CI, 1.365–4.219; P = 0.002) and postoperative surgical complications (OR 2.514; 95% CI, 1.230–5.136; P = 0.011). The mean death-censored graft survival was significantly lower in obese patients (normal weight: 16.3 ± 0.6 years, overweight: 16.3 ± 0.8 years, obese 10.8 ± 1.5 years, respectively; P = 0.001). However, when using the Cox proportional hazards model, the association between recipient obesity and death-censored renal graft failure disappeared, after adjustment for important covariates, whereas the principal independent predictors of graft loss were recipient diabetes mellitus and hypertension and kidneys from donors with expanded donor criteria. Conclusion In conclusion, obesity increases the risk of DGF and post-operative surgical complications after primary KT. Appropriate risk-adapted information concerning this must be provided to such patients before KT. Furthermore, obesity-typical concomitant diseases seem to negatively influence graft survival and need to be considered after the transplantation of obese patients.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Recipient obesity as a risk factor in kidney transplantation

et al. 2022

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“…Data from a French cohort including 4691 kidney transplant patients, 747 of whom were obese, also showed an increased risk of death in obese patients compared to non-obese subjects [ 69 ].…”

Section: Morbidity and Mortality In Patients With Obesity After Kidney Transplantationmentioning

confidence: 99%

“…Historically, obese kidney transplant recipients have tended to have a higher risk of delayed transplant function, wound complications, surgical site infection, and long-term hospitalization [ 69 ]. Thus, obesity has become a major economic and health burden for kidney transplantation, and early studies have shown that post-transplant side effects increase as BMI increases [ 5 , 17 , 46 ], although its relevance in recent studies was not so clear [ 47 ].…”

Section: Morbidity and Mortality In Patients With Obesity After Kidney Transplantationmentioning

confidence: 99%

“…Worse outcome differences, described by Modlin et al in 127 obese kidney transplant patients (BMI > 30 kg/m 2 ) compared with a matched non-obese control group (BMI < 27 kg/m 2 ), were primarily due to a higher mortality resulting from cardiac events [ 27 ]. In the French cohort, obese kidney transplant patients were also at a higher risk of cardiac complications compared to non-obese patients [ 69 ].…”

Section: Morbidity and Mortality In Patients With Obesity After Kidney Transplantationmentioning

confidence: 99%

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Obesity and Post-Transplant Diabetes Mellitus in Kidney Transplantation

Martín-Moreno

Shin

Chandraker

2021

JCM

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Worldwide, the prevalence obesity, diabetes, and chronic kidney disease is increasing apace. The relationship between obesity and chronic kidney disease is multidimensional, especially when diabetes is also considered. The optimal treatment of patients with chronic kidney disease includes the need to consider weight loss as part of the treatment. The exact relationship between obesity and kidney function before and after transplantation is not as clear as previously imagined. Historically, patients with obesity had worse outcomes following kidney transplantation and weight loss before surgery was encouraged. However, recent studies have found less of a correlation between obesity and transplant outcomes. Transplantation itself is also a risk factor for developing diabetes, a condition known as post-transplant diabetes mellitus, and is related to the use of immunosuppressive medications and weight gain following transplantation. Newer classes of anti-diabetic medications, namely SGLT-2 inhibitors and GLP-1 agonists, are increasingly being recognized, not only for their ability to control diabetes, but also for their cardio and renoprotective effects. This article reviews the current state of knowledge on the management of obesity and post-transplant diabetes mellitus for kidney transplant patients.

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Obesity and chronic kidney disease: A current review

Nawaz

Chinnadurai

Al-Chalabi

et al. 2022

Obesity Science & Practice

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Background Obesity poses significant challenges to healthcare globally, particularly through its bi‐directional relationship with co‐morbid metabolic conditions such as type 2 diabetes and hypertension. There is also emerging evidence of an association between obesity and chronic kidney disease (CKD) which is less well characterized. Methods A literature search of electronic libraries was conducted to identify and present a narrative review of the interplay between obesity and CKD. Findings Obesity may predispose to CKD directly as it is linked to the histopathological finding of obesity‐related glomerulopathy and indirectly through its widely recognized complications such as atherosclerosis, hypertension, and type 2 diabetes. The biochemical and endocrine products of adipose tissue contribute to pathophysiological processes such as inflammation, oxidative stress, endothelial dysfunction, and proteinuria. The prevention and management of obesity may prove critical in counteracting both the development and advancement of CKD. Moreover, measures of abdominal adiposity such as waist circumference, are generally associated with worse morbidity and mortality in individuals receiving maintenance hemodialysis. Conclusion Obesity is a risk factor for the onset and progression of CKD and should be recognized as a potential target for a preventative public health approach to reduce CKD rates within the general population. Future research should focus on the use of glucagon‐like peptide‐1 receptor agonists and sodium–glucose cotransporter 2 inhibitors in patients with CKD and obesity due to their multi‐faceted actions on major outcomes.

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Renal transplantation outcomes in obese patients: a French cohort-based study

Cited by 18 publications

References 31 publications

Recipient obesity as a risk factor in kidney transplantation

Recipient obesity as a risk factor in kidney transplantation

Obesity and Post-Transplant Diabetes Mellitus in Kidney Transplantation

Obesity and chronic kidney disease: A current review

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