Top

Published in:

Open Access 01-12-2022 | Kidney Transplantation | Research

Recipient obesity as a risk factor in kidney transplantation

Authors: Uwe Scheuermann, Jonas Babel, Uta-Carolin Pietsch, Antje Weimann, Orestis Lyros, Katrin Semmling, Hans-Michael Hau, Daniel Seehofer, Sebastian Rademacher, Robert Sucher

Published in: BMC Nephrology | Issue 1/2022

Abstract

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.

Rana A, Gruessner A, Agopian VG, Khalpey Z, Riaz IB, Kaplan B, Halazun KJ, Busuttil RW, Gruessner RW. Survival benefit of solid-organ transplant in the United States. JAMA Surg. 2015;150(3):252–9. https://doi.org/10.1001/jamasurg.2014.2038. PMID: 25629390.CrossRefPubMed

Sureshkumar KK, Patel BM, Markatos A, Nghiem DD, Marcus RJ. Quality of life after organ transplantation in type 1 diabetics with end-stage renal disease. Clin Transpl. 2006;20(1):19–25 PubMed PMID: 16556148.CrossRef

Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, Klarenbach S, Gill J. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant. 2011;11(10):2093–109. https://doi.org/10.1111/j.1600-6143.2011.03686.x. Epub 2011 Aug 30 PMID: 21883901.CrossRef

OECD. Health at a Glance, 2019 OECD Indicators OECD Publishing, Paris 2021 https://doi.org/10.1787/4dd50c09-en;2019. Accessed 11 July 2021.

Tsujimoto T, Sairenchi T, Iso H, Irie F, Yamagishi K, Watanabe H, Tanaka K, Muto T, Ota H. The dose-response relationship between body mass index and the risk of incident stage ≥3 chronic kidney disease in a general japanese population: the Ibaraki prefectural health study (IPHS). J Epidemiol. 2014;24(6):444–51. https://doi.org/10.2188/jea.je20140028 Epub 2014 Jul 5. PMID: 24998954; PMCID: PMC4213218.CrossRefPubMed

Wang Y, Chen X, Song Y, Caballero B, Cheskin LJ. Association between obesity and kidney disease: a systematic review and meta-analysis. Kidney Int. 2008;73(1):19–33. https://doi.org/10.1038/sj.ki.5002586Epub 2007 Oct 10 PMID: 17928825.CrossRefPubMed

Hart A, Lentine KL, Smith JM, Miller JM, Skeans MA, Prentice M, Robinson A, Foutz J, Booker SE, Israni AK, Hirose R, Snyder JJ. OPTN/SRTR 2019 Annual Data Report: Kidney. Am J Transplant. 2021;21(Suppl 2):21–137. https://doi.org/10.1111/ajt.16502PMID: 33595191.CrossRefPubMed

Kramer HJ, Saranathan A, Luke A, Durazo-Arvizu RA, Guichan C, Hou S, Cooper R. Increasing body mass index and obesity in the incident ESRD population. J Am Soc Nephrol. 2006;17(5):1453–9. https://doi.org/10.1681/ASN.2005111241 Epub 2006 Apr 5 PMID:16597682.CrossRefPubMed

McCullough KP, Morgenstern H, Saran R, Herman WH, Robinson BM. Projecting ESRD Incidence and Prevalence in the United States through 2030. J Am Soc Nephrol. 2019;30(1):127–35. https://doi.org/10.1681/ASN.2018050531 Epub 2018 Dec 17. PMID: 30559143; PMCID: PMC6317596.CrossRefPubMed

10.

Ri M, Aikou S, Seto Y. Obesity as a surgical risk factor. Ann Gastroenterol Surg. 2017;2(1):13–21. https://doi.org/10.1002/ags3.12049 PMID:29863119; PMCID:PMC5881295.CrossRefPubMedPubMedCentral

11.

Tjeertes EK, Hoeks SE, Beks SB, Valentijn TM, Hoofwijk AG, Stolker RJ. Obesity–a risk factor for postoperative complications in general surgery? BMC Anesthesiol. 2015;15:155. https://doi.org/10.1186/s12871-015-0096-7 Tjeertes,ElkeEKM[correctedtoTjeertes,EKM];Hoeks,SanneSE[correctedtoHoeks,SE];Beks,SabineSBJC[correctedtoBeks,SBJ];Valentign,TabitaTM[correctedtoValentijn,TM];Hoofwijk,AntonAGM[correctedtoHoofwijk,AGM];Sto.PMID:26228844;PMCID:PMC4520073 .CrossRefPubMedPubMedCentral

12.

Winfield RD, Reese S, Bochicchio K, Mazuski JE, Bochicchio GV. Obesity and the Risk for Surgical Site Infection in Abdominal Surgery. Am Surg. 2016;82(4):331–6 PMID: 27097626.CrossRef

13.

Doyle SL, Lysaght J, Reynolds JV. Obesity and post-operative complications in patients undergoing non-bariatric surgery. Obes Rev. 2010;11(12):875–86. https://doi.org/10.1111/j.1467-789X.2009.00700.x PMID: 20025695.CrossRefPubMed

14.

Siedlecki A, Irish W, Brennan DC. Delayed graft function in the kidney transplant. Am J Transplant. 2011;11(11):2279–96. https://doi.org/10.1111/j.1600-6143.2011.03754.x Epub 2011 Sep 19. PMID: 21929642; PMCID: PMC3280444.CrossRefPubMedPubMedCentral

15.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRef

16.

World Health Organization. Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight; 2021. Accessed 11 July 2021.

17.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12. https://doi.org/10.7326/0003-4819-150-9-200905050-00006 Erratum in: Ann Intern Med. 2011 Sep 20;155(6):408. PMID: 19414839; PMCID: PMC2763564.CrossRefPubMedPubMedCentral

18.

Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known. 1916. Nutrition. 1989;5(5):303–11 discussion 312–3. PMID: 2520314.PubMed

19.

Zieschang S. „Genau richtig dosieren“ bei Niereninsuffizienz – aber wie? Arzneiverordnung in der Praxis Band 47 Heft 1–2 März 2020 https://www.akdae.de/Arzneimitteltherapie/AVP/Artikel/2020-1-2/018h/index.php; 2020. Accessed 20 July 2021.

20.

Rao PS, Ojo A. The alphabet soup of kidney transplantation: SCD, DCD, ECD– fundamentals for the practicing nephrologist. Clin J Am Soc Nephrol. 2009;4(11):1827–31.CrossRef

21.

Eurotransplant. Chapter 9: The Donor. https://www.eurotransplant.org/wp-content/uploads/2020/01/H9-The-Donor-Februar-2020.pdf; 2020. Accessed 11 July 2021.

22.

Ladurner R, Steurer W. Technik der Multiorganentnahme. Viszeralchirurgie. 2004;39:439–42.CrossRef

23.

Sollinger HW, Odorico JS, Becker YT, D’Alessandro AM, Pirsch JD. One thousand simultaneous pancreas-kidney transplants at a single center with 22-year follow-up. Ann Surg. 2009;250:618–30.CrossRef

24.

Sollinger HW, Odorico JS, Knechtle SJ, D’Alessandro AM, Kalayoglu M, Pirsch JD. Experience with 500 simultaneous pancreas-kidney transplants. Ann Surg. 1998;228:284–96.CrossRef

25.

Lafranca JA, IJermans JN, Betjes MG, Dor FJ. Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis. BMC Med. 2015;13:111. https://doi.org/10.1186/s12916-015-0340-5 Erratum in: BMC Med. 2015;13:141. PMID: 25963131; PMCID: PMC4427990.CrossRefPubMedPubMedCentral

26.

Furriel F, Parada B, Campos L, Moreira P, Castelo D, Dias V, Mota A. Pretransplantation overweight and obesity: does it really affect kidney transplantation outcomes? Transplant Proc. 2011;43(1):95–9. https://doi.org/10.1016/j.transproceed.2010.12.027 PMID: 21335163.CrossRefPubMed

27.

Orlic L, Mikolasevic I, Jakopcic I, Grskovic A, JelicPranjic I, Racki S, Stimac D. Body mass index: short- and long-term impact on kidney transplantation. Int J Clin Pract. 2015;69(11):1357–65. https://doi.org/10.1111/ijcp.12715 Epub 2015 Aug 12 PMID: 26268780.CrossRefPubMed

28.

Singh D, Lawen J, Alkhudair W. Does pretransplant obesity affect the outcome in kidney transplant recipients? Transplant Proc. 2005;37(2):717–20. https://doi.org/10.1016/j.transproceed.2004.12.033 PMID: 15848512.CrossRefPubMed

29.

Gore JL, Pham PT, Danovitch GM, Wilkinson AH, Rosenthal JT, Lipshutz GS, Singer JS. Obesity and outcome following renal transplantation. Am J Transplant. 2006;6(2):357–63. https://doi.org/10.1111/j.1600-6143.2005.01198.x PMID: 16426321.CrossRefPubMed

30.

Grosso G, Corona D, Mistretta A, Zerbo D, Sinagra N, Giaquinta A, Caglià P, Amodeo C, Leonardi A, Gula R, Veroux P, Veroux M. The role of obesity in kidney transplantation outcome. Transplant Proc. 2012;44(7):1864–8. https://doi.org/10.1016/j.transproceed.2012.06.043 PMID: 22974857.CrossRefPubMed

31.

Aziz F, Ramadorai A, Parajuli S, Garg N, Mohamed M, Mandelbrot DA, Foley DP, Garren M, Djamali A. Obesity: An Independent Predictor of Morbidity and Graft Loss after Kidney Transplantation. Am J Nephrol. 2020;51(8):615–23. https://doi.org/10.1159/000509105 Epub 2020 Jul 28 PMID: 32721967.CrossRefPubMed

32.

Lentine KL, Rocca-Rey LA, Bacchi G, Wasi N, Schmitz L, Salvalaggio PR, Abbott KC, Schnitzler MA, Neri L, Brennan DC. Obesity and cardiac risk after kidney transplantation: experience at one center and comprehensive literature review. Transplantation. 2008;86(2):303–12. https://doi.org/10.1097/TP.0b013e31817ef0f9 PMID:18645495;PMCID:PMC2614624.CrossRefPubMedPubMedCentral

33.

Foucher Y, Lorent M, Albano L, Roux S, Pernin V, Le Quintrec M, Legendre C, Buron F, Morelon E, Girerd S, Ladrière M, Glotz D, Lefaucher C, Kerleau C, Dantal J, Branchereau J, Giral M, DIVAT consortium. Renal transplantation outcomes in obese patients: a French cohort-based study. BMC Nephrol. 2021;22(1):79. https://doi.org/10.1186/s12882-021-02278-1 PMID: 33673808; PMCID: PMC7934368.CrossRefPubMedPubMedCentral

34.

Weissenbacher A, Jara M, Ulmer H, Biebl M, Bösmüller C, Schneeberger S, Mayer G, Pratschke J, Öllinger R. Recipient and donor body mass index as important risk factors for delayed kidney graft function. Transplantation. 2012;93(5):524–9. https://doi.org/10.1097/TP.0b013e318243c6e4 PMID: 22362367.CrossRefPubMed

35.

Perico N, Cattaneo D, Sayegh MH, Remuzzi G. Delayed graft function in kidney transplantation. Lancet. 2004;364(9447):1814–27. https://doi.org/10.1016/S0140-6736(04)17406-0 PMID: 15541456.CrossRefPubMed

36.

Cannon RM, Jones CM, Hughes MG, Eng M, Marvin MR. The impact of recipient obesity on outcomes after renal transplantation. Ann Surg. 2013;257(5):978–84. https://doi.org/10.1097/SLA.0b013e318275a6cb PMID: 23295317.CrossRefPubMed

37.

Molnar MZ, Kovesdy CP, Mucsi I, Bunnapradist S, Streja E, Krishnan M, Kalantar-Zadeh K. Higher recipient body mass index is associated with post-transplant delayed kidney graft function. Kidney Int. 2011;80(2):218–24. https://doi.org/10.1038/ki.2011.114 Epub 2011 Apr 27. PMID: 21525853; PMCID: PMC5489124.CrossRefPubMedPubMedCentral

38.

Yarlagadda SG, Coca SG, Formica RN Jr, Poggio ED, Parikh CR. Association between delayed graft function and allograft and patient survival: a systematic review and meta-analysis. Nephrol Dial Transplant. 2009;24(3):1039–47. https://doi.org/10.1093/ndt/gfn667 Epub 2008 Dec 22 PMID: 19103734.CrossRef

39.

Curran SP, Famure O, Li Y, Kim SJ. Increased recipient body mass index is associated with acute rejection and other adverse outcomes after kidney transplantation. Transplantation. 2014;97(1):64–70. https://doi.org/10.1097/TP.0b013e3182a688a4 PMID: 24056619.CrossRefPubMed

40.

Shibata N, Hoshino N, Minouchi T, Yamaji A, Park K, Tomoyoshi T, Abe H, Kodama M. Relationship between area under the concentration versus time curve of cyclosporin A, creatinine clearance, hematocrit value, and other clinical factors in Japanese renal transplant patients. Int J Clin Pharmacol Ther. 1998;36(4):202–9 PMID: 9587046.PubMed

41.

Okamoto Y, Christen T, Shimizu K, Asano K, Kihara S, Mitchell RN, Libby P. Adiponectin inhibits allograft rejection in murine cardiac transplantation. Transplantation. 2009;88(7):879–83. https://doi.org/10.1097/TP.0b013e3181b6efbf PMID:19935458;PMCID:PMC2784664.CrossRefPubMedPubMedCentral

42.

Quante M, Dietrich A, ElKhal A, Tullius SG. Obesity-related immune responses and their impact on surgical outcomes. Int J Obes (Lond). 2015;39(6):877–83. https://doi.org/10.1038/ijo.2015.21 Epub 2015 Feb 20 PMID: 25697667.CrossRef

43.

Bosma RJ, Kwakernaak AJ, van der Heide JJ, de Jong PE, Navis GJ. Body mass index and glomerular hyperfiltration in renal transplant recipients: cross-sectional analysis and long-term impact. Am J Transplant. 2007;7(3):645–52. https://doi.org/10.1111/j.1600-6143.2006.01672.x Epub 2007 Jan 22 PMID: 17250561.CrossRefPubMed

44.

Naik AS, Sakhuja A, Cibrik DM, Ojo AO, Samaniego-Picota MD, Lentine KL. The Impact of Obesity on Allograft Failure After Kidney Transplantation: A Competing Risks Analysis. Transplantation. 2016;100(9):1963–9. https://doi.org/10.1097/TP.0000000000000983 PMID: 26569067.CrossRefPubMed

45.

Kostakis ID, Kassimatis T, Bianchi V, Paraskeva P, Flach C, Callaghan C, Phillips BL, Karydis N, Kessaris N, Calder F, Loukopoulos I. UK renal transplant outcomes in low and high BMI recipients: the need for a national policy. J Nephrol. 2020;33(2):371–81. https://doi.org/10.1007/s40620-019-00654-7 Epub 2019.CrossRefPubMed

46.

Gusukuma LW, Harada KM, Baptista AP, Alencar MR, de Sandes-Freitas TV, Tedesco-Silva H Jr, Medina-Pestana JO. Outcomes in obese kidney transplant recipients. Transplant Proc. 2014;46(10):3416–9. https://doi.org/10.1016/j.transproceed.2014.09.112.PMID:25498063.Oct3 PMID: 31583535.CrossRefPubMed

47.

Moreira TR, Bassani T, de Souza G, Manfro RC, Gonçalves LF. Obesity in kidney transplant recipients: association with decline in glomerular filtration rate. Ren Fail. 2013;35(9):1199–203. https://doi.org/10.3109/0886022X.2013.819735 Epub 2013 Aug 1 PMID: 23902319.CrossRefPubMed

Title: Recipient obesity as a risk factor in kidney transplantation
Authors: Uwe Scheuermann
Jonas Babel
Uta-Carolin Pietsch
Antje Weimann
Orestis Lyros
Katrin Semmling
Hans-Michael Hau
Daniel Seehofer
Sebastian Rademacher
Robert Sucher
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Kidney Transplantation
Obesity
Obesity
Kidney Transplantation
Kidney Transplantation
Kidney Transplantation
Kidney Transplantation
Kidney Transplantation
Overweight
Published in: BMC Nephrology / Issue 1/2022
Electronic ISSN: 1471-2369
DOI: https://doi.org/10.1186/s12882-022-02668-z

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Recipient obesity as a risk factor in kidney transplantation

Abstract

Background

Patients and methods

Results

Conclusion

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Recurrent peritonitis relapse in a patient with atrial septal defect undergoing peritoneal dialysis: a case report

Histopathology pattern and survival analysis of patients with kidney biopsy in the top end of Northern Australia from 2007 to 2020

A rare case of Immunoglobulin A dominant post-infectious glomerulonephritis (IgA PIGN) in a young patient

Referral criteria for chronic kidney disease: implications for disease management and healthcare expenditure—analysis of a population-based sample

Chronic kidney disease mediates cardiac dysfunction associated with increased resident cardiac macrophages

Serum leptin level and incidence of CKD: a longitudinal study of adult enrolled in the Korean genome and epidemiology study(KoGES)

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page