Original Investigations: TransplantationDemographics and trends in overweight and obesity in patients at time of kidney transplantation
Abstract
Background: The epidemic of overweight and obesity is one of the most serious public health problems in the United States, although information regarding its effect on chronic kidney transplant patients is sparse. The authors describe the prevalence, demographics, and trends in overweight and obesity at the time of kidney transplantation. Methods: Data were obtained from a national transplant database that included all kidney transplants since 1987. Body mass indices (BMI) at time of transplantation were stratified by demographic categories and year. Trends of overweight and obesity between the general population and subjects undergoing kidney transplantation were compared. Logistic regression analyses were performed to identify variables associated with increased likelihood of being obese. Results: The majority (60%) of subjects at time of transplantation currently are overweight or obese. Between 1987 and 2001, the proportion of obese transplant recipients rose by 116%. The rate of increase was grossly similar to that in the general population. The likelihood of being obese increased with age, female sex, noninsulin-dependent diabetes mellitus, black race, and the more recent the transplant year. Conversely, the proportion of recipients with lower BMI fell by approximately 50%. Conclusions: Overweight and obesity are very prevalent at the time of kidney transplantation and are eclipsing protein-energy malnutrition as the more common nutritional illness. This may have profound negative effects on patient and allograft outcomes. Nephrologists may need to reexamine traditional notions of nutritional disease and therapeutic strategies to more effectively deal with this formidable challenge. Am J Kidney Dis 41:480-487.
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Overview of Renal Transplantation for Primary Care Physicians: Workup, Complications, and Management
2023, Medical Clinics of North AmericaEffect of Recipient Body Mass Index on Kidney Transplantation Outcomes: A Systematic Review and Meta-analysis by the Transplant Committee from the French Association of Urology
2023, European Urology FocusThe impact of recipient obesity on kidney transplantation (KT) outcomes remains unclear.
The aim of this study was to perform a systematic review and meta-analysis to appraise all available evidence on the outcomes of KT in obese patients (body mass index [BMI] ≥30 kg/m2) versus nonobese patients (BMI <30 kg/m2).
A systematic review and meta-analysis was performed. Search was conducted in the MEDLINE OvidSP, Web of Science, Google Scholar, Embase, and Cochrane databases to identify all studies reporting the outcomes of KT in obese versus nonobese recipients.
Fifty-two articles met the inclusion criteria. Delayed graft function and surgical complications were significantly higher in obese recipients (delayed graft function: relative risk [RR]: 1.44, 95% confidence interval [CI]: 1.32–1.57, p < 0.01; surgical complications: RR: 1.74, 95% CI: 1.36–2.22, p < 0.0001). Five-year patient survival (RR: 0.96, 95% CI: 0.92–1.00, p = 0.01), 10-yr patient survival (RR: 0.90, 95% CI: 0.84–0.97, p = 0.006), and 10-yr graft survival (RR: 0.87, 95% CI: 0.79–0.96, p = 0.01) were significantly inferior in the obese group.
KT in obese recipients was associated with lower patient and graft survival, and higher delayed graft function, acute rejection, and medical and surgical complications than nonobese recipients. In the current situation of organ shortage and increasing prevalence of obesity, ways to optimize KT in this setting should be investigated.
Compared with nonobese population, kidney transplantation in obese recipients has inferior patient and graft survival, and higher medical and surgical complications.
Impact of Recipient Obesity on Kidney Transplantation Outcome: A Retrospective Cohort Study with a Matched Comparison
2022, Transplantation ProceedingsThe aim of this study was to evaluate the effect of a recipient's obesity on posttransplant complications and patient and graft survival.
A single-institution, retrospective study was performed on obese renal transplant recipients (BMI ≥ 30 kg/m2, n = 102) from January 2010 to December 2018, matched with non-obese recipients (BMI < 30 kg/m2, n = 204). For comparison, for every obese patient we selected 2 nonobese patients with a similar age, sex, and period of transplantation. The comparative analysis included patient and graft survival as primary outcomes and graft function and postoperative complications as a secondary outcome.
Recipient demographics were comparable in both groups except for diabetic nephropathy in obese patients (P = .0006). Obesity was strongly related to a poorer patient survival (risk ratio [RR] = 2.83 confidence interval [CI] 95% 1.14-7.04; P = .020) but there was no observed difference in graft survival (P = .6). While early graft function was inferior in the obese population (RR = 2.41; CI 95% 1.53-3.79; P = .00016), during late follow-up, no statistically significant differences were observed between both groups (P = .36). Obese recipients had a significantly higher risk of delayed graft function (RR = 1.93; CI 95% (1.19-3.1), P = .0077), heart infarction (RR = 7; CI 95% 1.68-29.26; P = .0042), wound infections (RR = 8; CI 95% 1.96-32.87; P = .0015), diabetes aggravation (RR = 3.13; CI 95% 1.29-7.6; P = .011), and surgical revision for eventration (RR = 8; CI 95% 1.22-52.82; P = .026) when compared with nonobese recipients.
Despite the inferior early kidney graft function in obese recipients, there was no difference observed at the long-term follow-up. However, recipient obesity demonstrated a negative effect on patient survival and postoperative complications.
Body Mass Index and Kidney Donor Profile Index as Prognostic Markers of the Outcome of Renal Transplantation
2021, Transplantation ProceedingsThe aim of this study was to determine the effects of Kidney Donor Profile Index (KDPI) and body mass index (BMI) of the deceased donor on the kidney allograft outcome 1 year after transplantation.
We retrospectively studied 98 deceased kidney allograft donors with a mean age of 56 ± 12 years. The donors were divided into 5 groups according to their BMI: Normal ΒΜΙ = 25 (n = 25); ΒΜΙ 25 to 29 = Overweight (n = 33); ΒΜΙ 30 to 34.9 = Obese class I (n = 19); ΒΜΙ 35 to 39 = Obese class ΙΙ (n = 11); and ΒΜΙ >40 = Obese class III (n = 10). We examined the impact of the deceased donor's BMI and KDPI on delayed graft function (DGF) and estimated renal glomerular filtration rate (eGFR) (measured by the Chronic Kidney Disease Epidemiology Collaboration equation) 1 year after transplantation.
Donor BMI significantly increased the prevalence of DGF (P = .031), and it was associated with higher cold ischemia time (P = .021). However, there was no significant association between the aforementioned BMI groups and 1-year eGFR (P = 0.57), as deceased grafts from donors with increased BMI (BMI > 40) gained sufficient renal function during the first year of transplantation. Moreover, high KDPI was associated not only with DGF (P = .015), but also with decreased values of eGFR (P = .033).
In this population, we identified no significant association between donor BMI and long-term clinical outcomes in deceased donor kidney transplants. KDPI, and not ΒΜΙ, of the deceased donor seems to be a good prognostic factor of renal function at the end of the first year after kidney transplant, whereas high BMI and high KDPI markedly induce DGF.
Bariatric surgery prior to transplantation and risk of early hospital re-admission, graft failure, or death following kidney transplantation
2021, American Journal of TransplantationBariatric surgery has been shown to be safe in the dialysis population. Whether bariatric surgery before kidney transplantation influences posttransplant outcomes has not been examined nationally. We included severely obese (BMI >35) dialysis patients between 18 and 70 years who received a kidney transplant according to the US Renal Data System. We determined the association between history of bariatric surgery and risk of 30-day readmission, graft failure, or death after transplantation using multivariable logistic, Fine-Gray, and Cox models. We included 12 573 patients, of whom 503 (4%) received bariatric surgery before transplantation. Median age at transplant was 53 years; 42% were women. Overall, history of bariatric surgery was not statistically significantly associated with graft failure (HR 1.02; 95% CI 0.77–1.35) or death (HR 1.10; 95% CI 0.84–1.45). However, sleeve gastrectomy (vs. no bariatric surgery) was associated with lower risk of graft failure (HR 0.39; 95% CI 0.16–0.95). In conclusion, history of bariatric surgery prior to kidney transplantation was not associated with allograft or patient survival, but findings varied by surgery type. Sleeve gastrectomy was associated with better graft survival and should be considered in severely obese transplant candidates receiving dialysis.
Food Literacy Is Associated With Adherence to a Mediterranean-Style Diet in Kidney Transplant Recipients
2021, Journal of Renal NutritionAdherence to a Mediterranean-style diet is associated with improved health outcomes in kidney transplant recipients (KTR). However, poor dietary habits, including excessive sodium intake, are common in KTR, indicating difficulties with incorporating a healthy diet into daily life. Food literacy is identified as potential facilitator of a healthy diet, but the precise relationship between food literacy and dietary intake in KTR has not been investigated. This study examined food literacy levels in KTR and its association with adherence to a Mediterranean-style diet and sodium intake.
This cross-sectional study is part of the TransplantLines Cohort and Biobank Study. Food literacy was measured with the Self-Perceived Food Literacy (SPFL) questionnaire. Dietary intake assessment with food frequency questionnaires was used to calculate the Mediterranean Diet Score. Sodium intake was based on the 24-hour urinary sodium excretion rate. Associations of SPFL with Mediterranean Diet Score and sodium intake were assessed with univariable and multivariable linear regression analyses.
In total, 148 KTR (age 56 [48-66]; 56% male) completed the SPFL questionnaire with a mean SPFL score of 3.63 ± 0.44. Higher SPFL was associated with a higher Mediterranean Diet Score in KTR (β = 1.51, 95% confidence interval 0.88-2.12, P ≤ .001). Although KTR with higher food literacy tended to have a lower sodium intake than those with lower food literacy (P = .08), the association of food literacy with sodium intake was not significant in a multivariable regression analysis (β = 0.52 per 10 mmol/24-hour increment, 95% confidence interval −1.79 to 2.83, P = .66).
Higher levels of food literacy are associated with better adherence to a Mediterranean-style diet in KTR. No association between food literacy and sodium intake was found. Further studies are needed to determine if interventions on improving food literacy contribute to a healthier diet and better long-term outcomes in KTR.