Body mass index affects kidney transplant outcomes: A cohort study over 5 years using a steroid sparing protocol

Abstract

BackgroundThere is controversy regarding the suitability of high body mass index (BMI) candidates accessing the transplant waitlist.Patients and methodsObservational study on consecutive kidney transplant recipients undergoing surgery between January 2014 and March 2016 at our center. Patients were stratified according to BMI. Survival outcomes and graft function were analyzed to investigate the effect of donor’s and recipient’s demographic characteristics.Results396 kidney transplant recipients: 260 males, mean age 51.8 ± 15.9 years, followed up for a mean time of 5.86 ± 2.29 years. Mean BMI 26.2 ± 5.1. BMI class 1 (20 ≤ BMI ≤ 24.9) n=133, class 2 (25 ≤ BMI ≤ 29.9) n= 155, class 3 (30 ≤ BMI ≤34.9) n=53, class 4 (BMI ≥ 35) n=21, class V (BMI ≤ 19.9) n=34. Patient survival was not significantly different according to the recipient’s BMI class (p=0.476); graft survival was affected (p=0.031), as well as graft function up to 2 years post-transplant and at 4 years follow up (p=0.016). At logistic regression the factors independently associated with graft loss were only donor’s age (p=0.05) and BMI class of the recipient (p=0.002).ConclusionsObesity did not impact on patient’s survival but affected graft function and graft loss.

Levels of Cell-Free DNA in Kidney Failure Patients before and after Renal Transplantation

“…In the preparation of patients for KT, incorporating essential criteria to facilitate optimal surgical outcome is paramount for identifying suitable candidates for transplant. One factor in consideration may involve ensuring an optimal nutritional status and physical condition to ensure the patient's capacity to withstand the surgical procedure [45,46]. Indeed, those with consistently increased total cfDNA levels had higher BMI, albumin, and troponin T levels, and low SBP.…”

Weight Loss and Sleep, Current Evidence in Animal Models and Humans

“…Bariatric surgery is considered an effective treatment for severe obesity and may have a beneficial effect on its comorbidities [83,84], such as disturbed sleep and its daytime consequences [85]. Weight loss surgeries are divided into three categories [86]: (1) laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) that reduce gastric pouch size; (2) biliopancreatic diversion (BPD) with or without duodenal switch (DS) that results in body malabsorption; (3) Roux-en-Y gastric bypass (RYGB) that results in a combination of restrictive and malabsorptive components.…”

Sleeve gastrectomy and one-year outcomes: Impact on cardiovascular, renal and metabolic parameters

“…Structural, hemodynamic, and metabolic alterations for which obesity has been hypothesized as the major responsible [ 5 ], can cause severe damage to the kidney [ 6 ], namely glomerular hypertension, hypertrophy, and hyperfiltration, and eventually leading to progressive glomerulosclerosis and loss of function [ 7 ]. These renal complications are seen in obesity-related glomerulopathy and represent the expression of a more generalized systemic damage reflecting an underlying chronic inflammatory state [ 8 ], as well as a direct effect of adiposity [ 9 ], for which, in the high body mass index (BMI) population, cardiovascular risk significantly increased [ 28 ].…”