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doi:10.6002/ect.2015.0295

Cited by 7 publications

(8 citation statements)

References 76 publications

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“…There are conflicting results regarding the association between patient and graft survival with obesity. While there are studies that have shown a negative impact of obesity on both patient and graft survival (81)(82)(83)(84)(85), others have found no association (86)(87)(88)(89). In a systematic review and meta-analyses that included 138,081 kidney transplant recipients, obesity was associated with increased graft failure but no differences were found between obese and non-obese patients in terms of survival (90).…”

Section: Impact Of Obesity Before and After Kidney Transplantationmentioning

confidence: 99%

“…The association between obesity and rejection is controversial. Some studies have shown an increased risk of rejection in this population (85,87,92,94,97), while others have not (86,(98)(99)(100)(101). There is an intrinsic problem in obese patients regarding the difficulty on achieving and adequate exposure to immunosuppression, with frequent overexposure resulting into calcineurin-inhibitor toxicity, or otherwise, underexposure, placing these patients at a higher risk of rejection (99).…”

Section: Impact Of Obesity Before and After Kidney Transplantationmentioning

confidence: 99%

“…Obese patients cannot be excluded from transplantation because of their BMI, since survival after transplantation is better than remaining on dialysis. Thus, management of these patients must include multidisciplinary strategies to lose weight, including the possibility of bariatric surgery in selected candidates as well as pharmacological treatments (85,108).…”

Section: Impact Of Obesity Before and After Kidney Transplantationmentioning

confidence: 99%

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A Nephrologist Perspective on Obesity: From Kidney Injury to Clinical Management

et al. 2021

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Obesity is one of the epidemics of our era. Its prevalence is higher than 30% in the U.S. and it is estimated to increase by 50% in 2030. Obesity is associated with a higher risk of all-cause mortality and it is known to be a cause of chronic kidney disease (CKD). Typically, obesity-related glomerulopathy (ORG) is ascribed to renal hemodynamic changes that lead to hyperfiltration, albuminuria and, finally, impairment in glomerular filtration rate due to glomerulosclerosis. Though not only hemodynamics are responsible for ORG: adipokines could cause local effects on mesangial and tubular cells and podocytes promoting maladaptive responses to hyperfiltration. Furthermore, hypertension and type 2 diabetes mellitus, two conditions generally associated with obesity, are both amplifiers of obesity injury in the renal parenchyma, as well as complications of overweight. As in the native kidney, obesity is also related to worse outcomes in kidney transplantation. Despite its impact in CKD and cardiovascular morbility and mortality, therapeutic strategies to fight against obesity-related CKD were limited for decades to renin-angiotensin blockade and bariatric surgery for patients who accomplished very restrictive criteria. Last years, different drugs have been approved or are under study for the treatment of obesity. Glucagon-like peptide-1 receptor agonists are promising in obesity-related CKD since they have shown benefits in terms of losing weight in obese patients, as well as preventing the onset of macroalbuminuria and slowing the decline of eGFR in type 2 diabetes. These new families of glucose-lowering drugs are a new frontier to be crossed by nephrologists to stop obesity-related CKD progression.

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Section: Impact Of Obesity Before and After Kidney Transplantationmentioning

confidence: 99%

Section: Impact Of Obesity Before and After Kidney Transplantationmentioning

confidence: 99%

Section: Impact Of Obesity Before and After Kidney Transplantationmentioning

confidence: 99%

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A Nephrologist Perspective on Obesity: From Kidney Injury to Clinical Management

et al. 2021

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“…Obese patients obtain a clear benefit from kidney transplant compared with staying on dialysis 52 , but high body mass index (BMI) is associated with a higher risk of PTDM and worse patient and allograft outcomes 53– 55 . Hence, many transplant centers exclude patients with high BMI from listing (BMI cutoff varies from 35 to 45 kg/m 2 between transplant centers 56 ).…”

Section: Post-transplantation Diabetes Mellitusmentioning

confidence: 99%

Non-immunological complications following kidney transplantation

2019

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Kidney transplantation (KT) is the most effective way to decrease the high morbidity and mortality of patients with end-stage renal disease. However, KT does not completely reverse the damage done by years of decreased kidney function and dialysis. Furthermore, new offending agents (in particular, immunosuppression) added in the post-transplant period increase the risk of complications. Cardiovascular (CV) disease, the leading cause of death in KT recipients, warrants pre-transplant screening based on risk factors. Nevertheless, the screening methods currently used have many shortcomings and a perfect screening modality does not exist. Risk factor modification in the pre- and post-transplant periods is of paramount importance to decrease the rate of CV complications post-transplant, either by lifestyle modification (for example, diet, exercise, and smoking cessation) or by pharmacological means (for example, statins, anti-hyperglycemics, and so on). Post-transplantation diabetes mellitus (PTDM) is a major contributor to mortality in this patient population. Although tacrolimus is a major contributor to PTDM development, changes in immunosuppression are limited by the higher risk of rejection with other agents. Immunosuppression has also been implicated in higher risk of malignancy; therefore, proper cancer screening is needed. Cancer immunotherapy is drastically changing the way certain types of cancer are treated in the general population; however, its use post-transplant is limited by the risk of allograft rejection. As expected, higher risk of infections is also encountered in transplant recipients. When caring for KT recipients, special attention is needed in screening methods, preventive measures, and treatment of infection with BK virus and cytomegalovirus. Hepatitis C virus infection is common in transplant candidates and in the deceased donor pool; however, newly developed direct-acting antivirals have been proven safe and effective in the pre- and post-transplant periods. The most important and recent developments on complications following KT are reviewed in this article.

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“…Rates of post-transplant obesity varied by age and gender. Results again underscore the need for specialized approaches to weight management in vulnerable groups (9).…”

Section: Psychosomatic Aspects Of Obesitymentioning

confidence: 86%