Is Body Mass Index a Significant Independent Risk Factor for Graft Failure and Patient Death in the Modern Immunosuppressive Era?

Kim, Sun Min; Choi, Jae Hyuc; Son, Mu Jin; Rim, Hark; Shin, Ho Sik

doi:10.1016/j.transproceed.2020.02.158

Cited by 3 publications

(5 citation statements)

References 29 publications

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“…Of these, 215 articles were excluded resulting in 154 studies that met the selection criteria. We excluded 25 studies with no usable data: 23 did not report baseline risk for mortality by BMI group, 17‐39 1 only reported a p value, 40 and another 1 mentioned data in a supplement that were not available 41 . Disagreements about the inclusion of studies occurred in 16% of the articles ( kappa = 0·67).…”

Section: Resultsmentioning

confidence: 99%

“…There were two studies 41,155 (three cohorts) that modeled BMI with splines (Table 3). The two cohorts from the same study both showed a decreasing curve; the other shape was quadratic convex.…”

Section: Resultsmentioning

confidence: 99%

“…The interaction terms for ≥5 years/ <5 years were non-significant. Including an interaction term for Asian/ non-Asian majority countries did significantly modify the adjusted There were two studies 41,155 (three cohorts) that modeled BMI with splines (Table 3). The two cohorts from the same study both showed a decreasing curve; the other shape was quadratic convex.…”

Section: Non-communicable Chronic Disease Populationsmentioning

confidence: 99%

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Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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SummaryFasting insulin and c‐reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the “average” associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non‐first order polynomials or splines. All‐cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2. Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β −0.829 [95% CI −1.313, −0.345] and adjusted β −0.746 [95% CI −1.471, −0.021]), Covid‐19 (unadjusted β −0.333 [95% CI −0.650, −0.015]), critically ill (adjusted β −0.550 [95% CI −1.091, −0.010]), and surgical (unadjusted β −0.415 [95% CI −0.824, −0.006]) populations. The associations for general, cancer, and non‐communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re‐examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Non-communicable Chronic Disease Populationsmentioning

confidence: 99%

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Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

2023

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“…Moreover, in a study that directly compared recipients from 1987 to 1999 and recipients from 2000 to 2016 in the Organ Procurement and Transplantation Network/United Network for Organ Sharing database, high BMI (≥ 30.0 kg/m 2 ) was still an independent risk factor for graft loss, but the relative risk significantly decreased after 2000 [24]. The authors suggested that the recent development of an immunosuppressive regimen and general medical practice for comorbidities in transplant recipients may be the reason for this phenomenon [23,24]. The International Obesity Task Force of the World Health Organization (WHO) recommends that the Asian population sets the BMI value of obesity to 25.0 kg/m 2 and the BMI value of overweight to 23.0 kg/m 2 when analyzing comorbidity risk [25].…”

Section: Discussionmentioning

confidence: 99%

“…The International Obesity Task Force of the World Health Organization (WHO) recommends that the Asian population sets the BMI value of obesity to 25.0 kg/m 2 and the BMI value of overweight to 23.0 kg/m 2 when analyzing comorbidity risk [ 25 ]. Previous studies that reported a worse allograft outcome in obesity (BMI ≥ 30 kg/m 2 ) were not studies involving Asian populations [ 7 , 21 , 23 , 24 ]. We considered that setting the obesity criterion to BMI 25.0 kg/m 2 according to the WHO recommendation would be appropriate for the Asian population in this study.…”

Section: Discussionmentioning

confidence: 99%

Impact of high body mass index on allograft outcomes in kidney transplant recipients with presensitization to human leukocyte antigen

Park

Lee

et al. 2021

Kidney Res Clin Pract

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Background: This study aimed to investigate whether high body mass index (BMI) and presensitization to human leukocyte antigen (HLA) in kidney transplant recipients (KTRs) affected allograft outcomes. Methods: From January 2010 to December 2018, 1,290 kidney transplantations (KTs) were performed at the Seoul St Mary's Hospital. Of these, 682 cases of ABO-compatible living donor KT patients were enrolled. They were divided into four groups (low BMI-non-sensitized, high BMI-non-sensitized, low BMI-sensitized, and high BMI-sensitized) according to the median BMI value (22.7 kg/m 2 ) and HLA presensitization status (anti-HLA antibody mean fluorescence intensity > 3,000). Short-term and long-term allograft outcomes were compared between groups. Results: In the high BMI-sensitized group, the decline in allograft function was higher than that in the other three groups. Death-censored graft loss (DCGL) rates were highest in the high BMI-sensitized group (4 of 21 [19.0%], p = 0.04). In the multivariable Cox regression hazard regression model analysis, the hazard ratio (HR) for DCGL was intensified when high BMI and presensitization statuses were combined (HR, 3.75; p = 0.03); these statuses significantly interacted with each other (p-value for interaction = 0.008).

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Management of obesity in kidney transplant candidates and recipients: A clinical practice guideline by the DESCARTES Working Group of ERA

Oniscu

Abramowicz

Bolignano

et al. 2021

Nephrology Dialysis Transplantation

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The clinical practice guideline ‘Management of obesity in kidney transplant candidates and recipients’ was developed to guide decision making in caring for people with end-stage kidney disease living with obesity. The document considers the challenges in defining obesity, weighs interventions for treating obesity in kidney transplant candidates as well as recipients and reflects on the impact of obesity on the likelihood of waitlisting as well as its effect on transplant outcomes. It was designed to inform management decisions related to this topic and provide the backdrop for shared decision making. This guideline was developed by ERA's Descartes working group on Transplantation. The group was supplemented with selected methodologists to supervise the project and provide methodological expertise in guideline development throughout the process. The guideline targets any health care professional treating or caring for people with end-stage kidney disease being considered for kidney transplantation or having received a donor kidney. This includes nephrologists, transplant physicians, transplant surgeons, general practitioners, dialysis and transplant nurses. Development of this guideline followed an explicit process of evidence review. Treatment approaches and guideline recommendations are based on systematic reviews of relevant studies, and appraisal of the quality of the evidence and the strength of recommendations followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Limitations of the evidence are discussed, and areas of future research are presented.

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Is Body Mass Index a Significant Independent Risk Factor for Graft Failure and Patient Death in the Modern Immunosuppressive Era?

Cited by 3 publications

References 29 publications

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Associations between body mass index and all‐cause mortality: A systematic review and meta‐analysis

Impact of high body mass index on allograft outcomes in kidney transplant recipients with presensitization to human leukocyte antigen

Management of obesity in kidney transplant candidates and recipients: A clinical practice guideline by the DESCARTES Working Group of ERA

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