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Open Access 01-12-2015 | Research article

Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis

Authors: Jeffrey A Lafranca, Jan NM IJermans, Michiel GH Betjes, Frank JMF Dor

Published in: BMC Medicine | Issue 1/2015

Abstract

Background

Whether overweight or obese end stage renal disease (ESRD) patients are suitable for renal transplantation (RT) is often debated. The objective of this review and meta-analysis was to systematically investigate the outcome of low versus high BMI recipients after RT.

Methods

Comprehensive searches were conducted in MEDLINE OvidSP, Web of Science, Google Scholar, Embase, and CENTRAL (the Cochrane Library 2014, issue 8). We reviewed four major guidelines that are available regarding (potential) RT recipients. The methodology was in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and written based on the PRISMA statement. The quality assessment of studies was performed by using the GRADE tool. A meta-analysis was performed using Review Manager 5.3. Random-effects models were used.

Results

After identifying 5,526 studies addressing this topic, 56 studies were included. We extracted data for 37 outcome measures (including data of more than 209,000 RT recipients), of which 26 could be meta-analysed. The following outcome measures demonstrated significant differences in favour of low BMI (<30) recipients: mortality (RR = 1.52), delayed graft function (RR = 1.52), acute rejection (RR = 1.17), 1-, 2-, and 3-year graft survival (RR = 0.97, 0.95, and 0.97), 1-, 2-, and 3-year patient survival (RR = 0.99, 0.99, and 0.99), wound infection and dehiscence (RR = 3.13 and 4.85), NODAT (RR = 2.24), length of hospital stay (2.31 days), operation duration (0.77 hours), hypertension (RR = 1.35), and incisional hernia (RR = 2.72). However, patient survival expressed in hazard ratios was in significant favour of high BMI recipients. Differences in other outcome parameters were not significant.

Conclusions

Several of the pooled outcome measurements show significant benefits for ‘low’ BMI (<30) recipients. Therefore, we postulate that ESRD patients with a BMI >30 preferably should lose weight prior to RT. If this cannot be achieved with common measures, in morbidly obese RT candidates, bariatric surgery could be considered.

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Title: Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis
Authors: Jeffrey A Lafranca
Jan NM IJermans
Michiel GH Betjes
Frank JMF Dor
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Medicine / Issue 1/2015
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-015-0340-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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