Effects of Obesity on Kidney Transplantation Outcomes

Nicoletto, Bruna Bellincanta; Fonseca, Natasha K.O.; Manfro, Roberto Ceratti; Gonçalves, Luiz Felipe Santos; Leitão, Cristiane Bauermann; Souza, Gabriela Corrêa

doi:10.1097/tp.0000000000000028

Cited by 171 publications

(134 citation statements)

References 42 publications

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“…In terms of survival, obese patients tend to have no decrease in short-term survival but may have attenuated overall survival; however, whether this is related to a decrease in graft function or other obesity-related effects is undetermined (27,33). In terms of graft survival, acute rejection tends to be increased in obese patients (27,34,37), and obesity is associated with delayed graft function in kidney transplantation (29)(30)(31)(32), hepatocellular carcinoma in liver transplants (27,33), and grade III primary graft dysfunction in lung transplants (27).…”

Section: How Does Obesity Affect Solid Organ Transplantation?mentioning

confidence: 99%

“…Studies have also been performed in the context of pancreas, lung, and heart transplantation, but their statistical power is limited due to small patient numbers. Generally, these epidemiological studies show that obese transplant recipients have more perioperative morbidities and tend to have longer hospital stays, possibly related to the obesity-associated risks of infection, sepsis, and longer ischemia times (27,(29)(30)(31)(32)(33)(34)(35)(36). In terms of survival, obese patients tend to have no decrease in short-term survival but may have attenuated overall survival; however, whether this is related to a decrease in graft function or other obesity-related effects is undetermined (27,33).…”

Section: How Does Obesity Affect Solid Organ Transplantation?mentioning

confidence: 99%

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Obesity-Associated Adipose Tissue Inflammation and Transplantation

Wu¹,

Dawson²,

Levings³

2016

American Journal of Transplantation

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Obesity is often associated with the development of adipose tissue (AT) inflammation, resulting in metabolic dysfunction and an increased risk for developing type 2 diabetes. It is also associated with multiple chronic diseases, including cardiovascular, liver, and kidney disease, and thus can contribute to organ failure. Several studies have investigated whether there is a correlation between obesity and outcomes in transplantation, but there is currently very limited information on the specific role of AT inflammation in the rejection process or on the overall function of the transplanted organ. Here, we provide a brief review of the current understanding of the cellular mechanisms that control obesity-associated AT inflammation and summarize knowledge about how obesity affects clinical outcomes following solid organ or hematopoietic stem cell transplantation. We also highlight opportunities for more research to better understand how obesity affects outcomes of transplantation.

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Section: How Does Obesity Affect Solid Organ Transplantation?mentioning

confidence: 99%

Section: How Does Obesity Affect Solid Organ Transplantation?mentioning

confidence: 99%

Obesity-Associated Adipose Tissue Inflammation and Transplantation

Wu¹,

Dawson²,

Levings³

2016

American Journal of Transplantation

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“…Adult studies report widely on the strong association between delayed graft function and obesity [17][18][19][20][21][22]. Some of the reasons for this association may relate to the technical challenges at the time of surgery, including a prolonged anastomotic time leading to longer warm ischaemia duration, whilst others may be related to the type of donor (donation after circulatory death) or the negative impact of higher calcineurin inhibitor doses.…”

Section: Graft Functionmentioning

confidence: 99%

“…However, a similar correlation at both ends of the BMI spectrum has not been described in the paediatric population. A recent meta-analysis suggested that in fact the association between BMI and poorer adult patient and graft survival was only present in the early reported studies and has been non-existent in studies conducted during the last 10 years [21] (Fig. 2).…”

Section: Patient and Graft Survivalmentioning

confidence: 99%

“…2 The overall effect of the body mass index (BMI) on patient survival at 1 year (a) and 5 years (b) after renal transplant and according to the study era (adapted from Nicoletto et al [21]; used with permission). M-H Metropolis-Hastings algorithm, CI confidence interval renal sodium reabsorption with impaired pressure natriuresis, increased activity of the renin-angiotensin-aldosterone system, expansion of the extracellular volume and physical compression of the kidneys [38].…”

Section: Cardiovascular Riskmentioning

confidence: 99%

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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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Metabolic Risk Profile and Graft Function Deterioration 2 Years After Kidney Transplant

Yan,

Yang,

Wang

et al. 2023

JAMA Netw Open

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ImportanceStudies exploring the association of body weight and metabolic status with graft function deterioration (GFD) after kidney transplantation have produced inconsistent findings. Few studies have examined whether metabolically healthy overweight or obesity (MHO) may contribute to GFD.ObjectiveTo evaluate associations of overweight or obesity and metabolic disorders with GFD in recipients of kidney transplant.Design, Setting, and ParticipantsThis multicenter retrospective cohort study was conducted from January 1, 2020, through June 30, 2021, with a follow-up period of 2 years after kidney transplantation. Participants included adult recipients of cadaveric kidney transplant in 4 transplantation centers in China. Participants were classified as 4 metabolic phenotypes according to their BMI and metabolic status. Data were analyzed from July to August 2023.ExposuresOverweight and obesity were characterized by body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 24 or greater. Metabolic disorder was identified by existence of a minimum of 2 of 4 conditions: hypertension, hyperglycemia, increased triglyceride, and decreased high-density lipoprotein cholesterol.Main Outcome and MeasuresThe main outcome was GFD, defined as a decrease in estimated glomerular filtration rate of at least 25% within 6 months to 2 years after transplant.ResultsA total of 1260 adult recipients of cadaveric kidney transplant (mean [SD] age, 43.97 [11.51] years; 755 [59.92%] male) were included in the study, and 127 (10.08%) participants experienced the primary outcome of GFD during follow-up. After accounting for confounding factors in multivariable analyses, overweight or obesity (odds ratio [OR], 1.64; 95% CI, 1.10-2.44; P = .02) and metabolic disorder (OR, 1.71; 95% CI, 1.12-2.63; P = .01) were associated with increased risk of GFD. The MHO subgroup exhibited a greater risk for GFD (OR, 2.37; 95% CI, 1.01-5.57; P = .048) compared with participants who did not have overweight or obesity or metabolic disorder. All components of metabolic disorder, with the exception of elevated triglyceride, were associated with GFD. There was a dose-response association of number of metabolic disorder components (OR per 1 additional condition, 1.40; 95% CI, 1.20-1.63; P &lt; .001) and BMI (OR per 1-unit increase, 1.90; 95% CI, 1.03-1.15; P = .002) with increased risk for GFD. A nonlinear association was observed between BMI and risk of GFD.Conclusions and RelevanceIn this cohort study of recipients of cadaveric kidney transplant, individuals with overweight or obesity or metabolic disorder had a significantly higher risk of experiencing GFD. Individuals with MHO had an elevated risk for graft function deterioration. Additional studies with larger sample size and longer follow-up are necessary to validate our findings.

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Effects of Obesity on Kidney Transplantation Outcomes

Abstract: In conclusion, obese patients have increased risk for DGF. In the past years, obesity was a risk factor for graft loss, death by CVD, and all-cause mortality. However, for the obese transplanted patient today, the graft and patient survival is the same as that of the nonobese patient.

Cited by 171 publications

References 42 publications

Obesity-Associated Adipose Tissue Inflammation and Transplantation

Obesity-Associated Adipose Tissue Inflammation and Transplantation

Paediatric obesity and renal transplantation: current challenges and solutions

Metabolic Risk Profile and Graft Function Deterioration 2 Years After Kidney Transplant

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