Weight changes after renal transplantation: a comparison between patients on 5-mg maintenance steroid therapy and those on steroid-free immunosuppressive therapy

Ham, E.C.H. van den; Kooman, Jeroen P.; Christiaans, Maarten H. L.; Nieman, Fred; Hooff, J. P. van

doi:10.1111/j.1432-2277.2003.tb00304.x

Cited by 67 publications

(8 citation statements)

References 13 publications

(8 reference statements)

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“…Increased cumulative prednisone dose because of anti‐rejection therapy did not result in an exaggerated weight gain. This confirms studies with adult and pediatric patients who exhibit a rapid increase in weight during steroid induction in the early phase after RTx without correlation to cumulative steroid dose (9, 15).…”

Section: Discussionsupporting

confidence: 84%

“…This is in accordance with data from Schaefer et al (12) who found a SDS BMI for height age of 1.0 ± 1.25 in peripubertal renal allograft recipients. In contrast to adult studies (3, 15), no influence of gender or dialysis modality on BMI after RTx could be detected. Increased cumulative prednisone dose because of anti‐rejection therapy did not result in an exaggerated weight gain.…”

Section: Discussioncontrasting

confidence: 78%

“…The magnitude of obesity in contributing to the cardiovascular risk is difficult to quantify but certainly every effort to prevent weight gain should be undertaken. This should include steroid avoidance (13) or withdrawal (14, 15) and blood pressure control (18) but also concentrate on dietary counseling and physical activity especially in children with an increased risk of becoming obese adults (19).…”

Section: Discussionmentioning

confidence: 99%

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Development of growth and body mass index after pediatric renal transplantation

Vester

Schaefer

Kranz

et al. 2005

Pediatric Transplantation

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Suboptimal final height and marked weight gain after renal transplantation (RTx) are common and may result in obesity. Steroid free immunosuppression has been advocated to improve growth and limit weight gain. We evaluated retrospectively the evolution of growth and body mass index (BMI) after renal transplantation to study risk factors for weight gain under steroid based treatment. Sixty-four pediatric patients (age 9.9 +/- 5.0 yr) were included in the study. To allow comparison between different age groups, standard deviation scores (SDS) for height and BMI for height age were calculated at time of transplantation and 3, 6, 9, 12, 24, 36, 48 and 60 months later. Induction immunosuppression consisted of basiliximab, cyclosporine and prednisone. Growth retardation at time of RTx was obvious with a SDS for height of -2.20 +/- 1.34. Height during the first year improved to an SDS of -2.0 +/- 1.27 (p < 0.01) but did further not increase in year 2 and 3. More than 40% of all patients remained 2 SDS below normal mean. SDS BMI for height age at transplantation was -0.19 +/- 0.98 and increased significantly during the first 3 months after transplantation to +0.64 +/- 1.07 (p < 0.01). Thereafter, BMI remained stable but did not decline to pretransplant values. A SDS BMI for height age of more than 2 SDS was observed in 2, 6, 9 and 11% of children at RTx and 1, 2 and 3 yr later respectively. BMI gain over 3 yr was significantly enhanced in children whose parents (especially the mother) were overweight. No influence of gender, BMI at RTx, dialysis modality prior to RTx or rejection episodes could be detected. We conclude that after RTx children exhibit some improvement in growth but height remains suboptimal. The BMI does increase significantly during the first months after RTx and does not return to baseline values under steroid-based immunosuppression. Obesity (>2 SDS above normal) does not occur more often than in the normal population. The most predictive parameter of inappropriate weight gain during 3 yr is the BMI of the mother. We would speculate that steroids may play a major role in weight gain in the early phase after RTx. However, genetic or environmental factors predict the long-term weight development.

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Section: Discussionsupporting

confidence: 84%

Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Development of growth and body mass index after pediatric renal transplantation

Vester

Schaefer

Kranz

et al. 2005

Pediatric Transplantation

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“…Within the transplant population, some determinants for weight gain are known, such as the use of corticosteroids . However, medication only partly explains post‐transplant weight gain . We hypothesized that lifestyle factors such as diet and physical activity play an important role in post‐transplant weight gain.…”

mentioning

confidence: 99%

The role of diet and physical activity in post‐transplant weight gain after renal transplantation

Zelle

Kok²,

Dontje

et al. 2013

Clinical Transplantation

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“…As the occurrence of overweight/obesity was not uniformly observed, excessive weight gain after transplantation described in the current study cannot be solely attributed to the use of steroid‐containing immunosuppressive regimens. As suggested by previous adult studies that evaluated steroid‐free protocols as compared with steroid minimization regimens, weight gain after transplantation is related to other factors than only to the use of steroids .…”

Section: Discussionmentioning

confidence: 98%

Single‐center assessment of nutritional counseling in preventing excessive weight gain in pediatric renal transplants recipients

Cameron

Krmar

2016

Pediatric Transplantation

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Post-transplantation obesity is a common complication that is associated with a higher risk for decreased allograft function and hypertension. However, the role of diet intervention on reducing post-transplantation obesity is relatively unknown. We investigated the clinical relevance of dietary counseling on the prevalence of overweight/obesity during the first two yr following renal transplantation. The computerized patient records of 42 recipients (31 males) aged 6.3 ± 4.8 yr at transplantation were reviewed. All patients systematically underwent yearly dietary assessment/counseling (motivational interviewing technique) and measurement of renal function and ABPM. At transplantation, 14.2% of patients were overweight/obese, which increased to 42.8% by two yr post-transplantation (p = 0.004). The majority of patients experienced a significant increase in BMI SDS during the first six months post-transplantation that remained sustained throughout the duration of the follow-up period (p = 0.001). By two yr post-transplantation, there were no observable differences between patients classified as having normal BMI or being overweight/obese with regard to renal function and controlled hypertension. The application of yearly tailored dietary assessment/counseling had a poor effect on preventing post-transplantation weight gain, suggesting the need for more comprehensive interventions to reduce post-transplant obesity.

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Weight changes after renal transplantation: a comparison between patients on 5-mg maintenance steroid therapy and those on steroid-free immunosuppressive therapy

Cited by 67 publications

References 13 publications

Development of growth and body mass index after pediatric renal transplantation

Development of growth and body mass index after pediatric renal transplantation

The role of diet and physical activity in post‐transplant weight gain after renal transplantation

Single‐center assessment of nutritional counseling in preventing excessive weight gain in pediatric renal transplants recipients

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