Body mass index: short- and long-term impact on kidney transplantation

Orlić, Lidija; Mikolašević, Ivana; Jakopčić, Ivan; Gršković, Antun; Pranjić, Ita Jelić; Rački, Sanjin; Stimac, Davor

doi:10.1111/ijcp.12715

Cited by 15 publications

(4 citation statements)

References 35 publications

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“…A higher incidence of acute rejection has been reported in higher BMI patients . This finding was questioned by Orlic et al, who did not find an association between recipients' BMI and the risk of acute rejection . In the present study, the overall rejection rate was 20.1% and, in most cases, successfully treated medically.…”

Section: Discussioncontrasting

confidence: 71%

Robotic kidney transplantation in the obese patient: 10-year experience from a single center

Tzvetanov

Spaggiari

Tulla

et al. 2020

American Journal of Transplantation

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Despite increasing obesity rates in the dialysis population, obese kidney transplant candidates are still denied transplantation by many centers. We performed a single‐center retrospective analysis of a robotic‐assisted kidney transplant (RAKT) cohort from January 2009 to December 2018. A total of 239 patients were included in this analysis. The median BMI was 41.4 kg/m2, with the majority (53.1%) of patients being African American and 69.4% of organs sourced from living donors. The median surgery duration and warm ischemia times were 4.8 hours and 45 minutes respectively. Wound complications (mostly seromas and hematomas) occurred in 3.8% of patients, with 1 patient developing a surgical site infection (SSI). Seventeen (7.1%) graft failures, mostly due to acute rejection, were reported during follow‐up. Patient survival was 98% and 95%, whereas graft survival was 98% and 93%, at 1 and 3 years respectively. Similar survival statistics were obtained from patients undergoing open transplant over the same time period from the UNOS database. In conclusion, RAKT can be safely performed in obese patients with minimal SSI risk, excellent graft function, and patient outcomes comparable to national data. RAKT could improve access to kidney transplantation in obese patients due to the low surgical complication rate.

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Section: Discussioncontrasting

confidence: 71%

Robotic kidney transplantation in the obese patient: 10-year experience from a single center

Tzvetanov

Spaggiari

Tulla

et al. 2020

American Journal of Transplantation

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“…In our study, the finding that BMI tended to be higher in patients with complete wound dehiscence who then required operative management or NPWT, is consistent with the published literature where BMI is a well-established risk factor for wound complications after kidney transplantation. A higher BMI has been found to be associated with not only fascial dehiscence and superficial breakdown [15, 16] but also surgical site infections [17–19], and hence the rates of wound complications overall [20–22]. The underlying cause for this is most likely multi-factorial but is thought to be related to decreased collagen deposition, increased tension on the fascial edges, high microbial loads on moist skin and in skin folds, impaired vascular supply and altered glucose metabolism [23].…”

Section: Discussionmentioning

confidence: 99%

Abdominal wall complications following renal transplantation in adult recipients – factors associated with interventional management in one unit

2019

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BackgroundAbdominal wall surgical site complications following renal transplantation can be challenging to manage. A sub-group of these recipients will require operative management or advanced wound care such as negative pressure wound therapy (NPWT). The aim of this study was to determine if there were any preoperative, intraoperative and postoperative characteristics in our recipients’ cohort which were associated with the requirement for such interventions.MethodsA retrospective review of medical records was performed for all recipients who sustained abdominal wall complications following renal transplantation at our centre from 2006 to 2016.ResultsA total of 64/828 recipients (7.7%) had abdominal wall complications. The mean weight for these patients was 84.9 kg (±16.6 kg) and the mean body mass index was 30.2 (±5.1). Forty-five recipients (70%) had a superficial wound dehiscence while nine (14%) had a complete fascial dehiscence. Operative intervention was required in 13/64 patients (20%) and was more likely to be required in the presence of a fascial dehiscence (9/9, 100%) or a wound collection (10/31, 32%) (p < 0.001, p = 0.021). NPWT was used in 17/64 patients (27%) and was more commonly required in patients with diabetes mellitus (10/24, 42%), a complete fascial dehiscence (5/9, 56%) or evidence of infection (16/44, 36%) (p = 0.039, p = 0.034, p = 0.008).ConclusionsThe requirement for either operative management or the use of NPWT in the management of abdominal wall complications following renal transplantation in our experience was more common in recipients with diabetes mellitus, and in the setting of either complete fascial dehiscence, abdominal wall wound collections and/ or infection.

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“…While life expectancy is longer after kidney transplantation, high BMI is an important contraindication for transplantation (although not an automatic disqualification in all centers), due to the poorer results obtained in obese patients [141,142,143,144,145,146,147,148]. Thus the paradoxical exclusion of obese patients, who are likely to have a longer life expectancy, from many transplant programs, underlines the many controversial facets of nutrition in dialysis [147].…”

Section: Diet and Dialysis: Four Paradoxesmentioning

confidence: 99%

The Diet and Haemodialysis Dyad: Three Eras, Four Open Questions and Four Paradoxes. A Narrative Review, Towards a Personalized, Patient-Centered Approach

et al. 2017

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The history of dialysis and diet can be viewed as a series of battles waged against potential threats to patients’ lives. In the early years of dialysis, potassium was identified as “the killer”, and the lists patients were given of forbidden foods included most plant-derived nourishment. As soon as dialysis became more efficient and survival increased, hyperphosphatemia, was identified as the enemy, generating an even longer list of banned aliments. Conversely, the “third era” finds us combating protein-energy wasting. This review discusses four questions and four paradoxes, regarding the diet-dialysis dyad: are the “magic numbers” of nutritional requirements (calories: 30–35 kcal/kg; proteins > 1.2 g/kg) still valid? Are the guidelines based on the metabolic needs of patients on “conventional” thrice-weekly bicarbonate dialysis applicable to different dialysis schedules, including daily dialysis or haemodiafiltration? The quantity of phosphate and potassium contained in processed and preserved foods may be significantly different from those in untreated foods: what are we eating? Is malnutrition one condition or a combination of conditions? The paradoxes: obesity is associated with higher survival in dialysis, losing weight is associated with mortality, but high BMI is a contraindication for kidney transplantation; it is difficult to limit phosphate intake when a patient is on a high-protein diet, such as the ones usually prescribed on dialysis; low serum albumin is associated with low dialysis efficiency and reduced survival, but on haemodiafiltration, high efficiency is coupled with albumin losses; banning plant derived food may limit consumption of “vascular healthy” food in a vulnerable population. Tailored approaches and agreed practices are needed so that we can identify attainable goals and pursue them in our fragile haemodialysis populations.

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Body mass index: short- and long-term impact on kidney transplantation

Abstract: Overweight and obese transplant candidates should not be excluded from kidney transplantation.

Cited by 15 publications

References 35 publications

Robotic kidney transplantation in the obese patient: 10-year experience from a single center

Robotic kidney transplantation in the obese patient: 10-year experience from a single center

Abdominal wall complications following renal transplantation in adult recipients – factors associated with interventional management in one unit

The Diet and Haemodialysis Dyad: Three Eras, Four Open Questions and Four Paradoxes. A Narrative Review, Towards a Personalized, Patient-Centered Approach

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