Effect of Obesity on the Outcome of Kidney Transplantation: A 20-Year Follow-Up

Hoogeveen, Ellen K.; Aalten, Jeroen; Rothman, Kenneth J.; Roodnat, Joke I.; Mallat, M.; Borm, George F.; Weimar, Willem; Hoitsma, Andries J.; Fijter, J. de

doi:10.1097/tp.0b013e3182100f3a

Cited by 178 publications

(147 citation statements)

References 29 publications

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“…Obesity is an established risk factor for cardiovascular disease and death in the general population (albeit a less important one in the elderly) and kidney transplant recipients (3,(6)(7)(8)(9). Several studies, but not all, have suggested that the effect of obesity in patients with ESRD undergoing maintenance dialysis is paradoxically in the opposite direction, showing that a high BMI is associated with improved survival (the so-called obesity paradox) (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Obesity and Mortality Risk among Younger Dialysis Patients

Hoogeveen

Halbesma²,

Rothman

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Many studies show that obesity in dialysis patients is not strongly associated with mortality but not whether this modest association is constant over age. This study investigated the extent to which the relation of body mass index (BMI) and mortality differs between younger and older dialysis patients.Design, setting, participants, & measurements Adult dialysis patients were prospectively followed from their first dialysis treatment for 7 years or until death or transplantation. Patients were stratified by age (,65 or $65 years) and baseline BMI (,20, 20-24 [reference], 25-29, and $30 kg/m 2 ).Results The study sample included 984 patients younger than 65 years and 765 patients 65 years or older; cumulative survival proportions at end of follow-up were 50% and 16%. Age-standardized mortality rate was 1.7 times higher in obese younger patients than those with normal BMI, corresponding to an excess rate of 5.2 deaths/100 patient-years. Mortality rates were almost equal between obese older patients and those with normal BMI. Excess rates of younger and older patients with low compared with normal BMI were 8.7 and 1.1 deaths/100 patient-years. After adjustment for age, sex, smoking, comorbidity, and treatment modality, hazard ratios by increasing BMI were 2.00, 1, 0.95, and 1.57 for younger patients and 1.07, 1, 0.88, and 0.91 for older patients, implying that obesity is a 1.7-fold (95% confidence interval, 1.1-to 2.9-fold) stronger risk factor in younger than older patients.Conclusions In contrast to older dialysis patients, younger patients with low or very high BMI had a substantially elevated risk for death.

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Section: Introductionmentioning

confidence: 99%

Obesity and Mortality Risk among Younger Dialysis Patients

Hoogeveen

Halbesma²,

Rothman

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…The hazard ratio (HR) for the presence of BPAR in obese recipients was calculated to be 1.51 (95% confidence interval [CI], 1.24-1.78). 23,26,29,30,37,40,41 Our evaluation showed that obese recipients had a significantly greater risk of BPAR after renal transplant (hetero geneity, I 2 = 17%; P < .01).…”

Section: Biopsy-proven Acute Rejectionmentioning

confidence: 95%

“…21,23,[30][31][32][33][34][35][36][37][38][39][40] The 13 studies assessed 48 719 patients. Allograft loss was defined in accordance with the journal Kidney International as "either the need to re-transplant, resume chronic hemodialysis, or undergo a nephrectomy.…”

Section: Allograft Lossmentioning

confidence: 99%

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Untitled

2016

Exp Clin Transplant

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Objectives: The prevalence of obesity is increasing rapidly and globally, yet systemic reviews on this topic are scarce. Our meta-analysis and systemic review aimed to assess how obesity affects 5 postoperative outcomes: biopsy-proven acute rejection, patient death, allograft loss, type 2 diabetes mellitus after transplant, and delayed graft function. Materials and Methods: We evaluated peer-reviewed literature from 22 medical databases. Studies were included if they were conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology criteria, only examined postoperative outcomes in adult patients, only examined the relation between recipient obesity at time of transplant and our 5 postoperative outcomes, and had a minimum score of > 5 stars on the Newcastle-Ottawa scale for nonrandomized studies. Reliable conclusions were ensured by having our studies examined against 2 internationally known scoring systems. Obesity was defined in accordance with the World Health Organization as having a body mass index of > 30 kg/m 2 . All obese recipients were compared versus "healthy" recipients (body mass index of 18.5-24.9 kg/m 2 ). Hazard ratios were calculated for biopsy-proven acute rejection, patient death, allograft loss, and type 2 diabetes mellitus after transplant. An odds ratio was calculated for delayed graft function. Results: We assessed 21 retrospective observational studies in our meta-analysis (N = 241 381 patients). In obese transplant recipients, hazard ratios were 1.51 (95% confidence interval, 1.24-1.78) for presence of biopsy-proven acute rejection, 1.19 (95% confidence interval, 1.10-1.31) for patient death, 1.54 (95% confidence interval, 1.38-1.68) for allograft loss, and 1.01 (95% confidence interval, 0.98-1.07) for development of type 2 diabetes mellitus. The odds ratio for delayed graft function was 1.81 (95% confidence interval, 1.51-2.13). Conclusions: Our meta-analysis clearly demonstrated greater risks for obese renal transplant recipients and poorer postoperative outcomes with obesity. We confidently recommend renal transplant candidates seek medically supervised weight loss before transplant.

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“…Although the prevalence of these risk factors decreased in the years following transplantation, they remained abnormally elevated, particularly as the incidence of excess weight increased during this period. The combination of central obesity, dyslipidaemia, hypertension and fasting hyperglycaemia characterises the metabolic syndrome with hyperlipidaemia, insulin resistance or post-transplantation diabetes and weight gain, all common findings following renal transplantation [41][42][43].…”

Section: Cardiovascular Riskmentioning

confidence: 99%

Paediatric obesity and renal transplantation: current challenges and solutions

Terrace

Oniscu

2015

Pediatr Nephrol

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The increased incidence of obesity in the paediatric population poses significant challenges to renal transplantation. Whilst the body mass index appears to be widely used as a measure of obesity in adults, there are no standardised definitions in the paediatric population, making comparative analyses difficult. In the paediatric transplant population, obesity is associated with an increased incidence of surgical complications, diabetes, hyperlipidaemia and cardiovascular morbidity, leading to diminished graft function and impacting patient and graft survival. Management of obesity in renal transplantation requires multiple interventions starting with lifestyle and behavioural modification combined with medical and possibly surgical therapies, representing a unique challenge in the childhood setting. In this review we discuss the current challenges of obesity and potential solutions in the setting of paediatric transplantation.

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Effect of Obesity on the Outcome of Kidney Transplantation: A 20-Year Follow-Up

Cited by 178 publications

References 29 publications

Obesity and Mortality Risk among Younger Dialysis Patients

Obesity and Mortality Risk among Younger Dialysis Patients

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Paediatric obesity and renal transplantation: current challenges and solutions

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