Obesity and long-term mortality risk among living kidney donors

Locke, Jayme E.; Reed, Rhiannon D.; Massie, Allan B.; MacLennan, Paul A.; Sawinski, Deirdre; Kumar, Vineeta; Snyder, Jon J.; Carter, Alexis J.; Shelton, Brittany A.; Mustian, Margaux N.; Lewis, Cora E.; Segev, Dorry L.

doi:10.1016/j.surg.2019.03.016

Cited by 32 publications

(23 citation statements)

References 28 publications

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“…Obese donors (BMI ≥ 30) have been reported to have an increased risk of diabetes mellitus, hypertension, and end-stage renal disease compared to non-obese donors (BMI < 30) during long-term follow-up after donation, although the absolute risk for these outcomes is relatively low [ 22 , 23 ]. Furthermore, a recent study has reported that obese living kidney donors (BMI ≥ 30) had a 30% increased risk of long-term mortality compared with their non-obese donors (BMI < 30) [ 24 ]. Accordingly, we need to select potential obese donors, and pay attention to not only short-term outcome but also long-term outcome of living donor candidates.…”

Section: Discussionmentioning

confidence: 99%

Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy

et al. 2019

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Background The aim of this study was to examine the difference in outcome between hand-assisted retroperitoneoscopic and laparoscopic living donor nephrectomy in obese donors, and the impact of donor body mass index on outcome. Methods Out of 1108 living donors who underwent hand-assisted retroperitoneoscopic or laparoscopic donor nephrectomy between 2010 and 2018, 205 were identified having body mass index ≥ 30. These donors were included in this retrospective study, analyzing postoperative outcomes and remnant renal function. Results Out of 205 donors, 137 (66.8%) underwent hand-assisted retroperitoneoscopic donor nephrectomy and 68 donors (33.2%) underwent laparoscopic donor nephrectomy. Postoperative outcome did not show any significant differences between the hand-assisted retroperitoneoscopic donor nephrectomy group and the laparoscopic donor nephrectomy group in terms of major complications (2.2% vs. 1.5%, P = 0.72), postoperative pain scale (4 vs. 4, P = 0.67), and the length of stay (3 days vs. 3 days, P = 0.075). The results of kidney function in donors after nephrectomy demonstrated no significant differences between the groups. Additional analysis of 29 donors with body mass index ≥ 35 (14.1%) as compared with 176 donors with body mass index 30-35 (85.9%) revealed no significant differences between groups in postoperative outcomes as well as kidney function after donation. Conclusion Our results show that laparoscopic living donor nephrectomy for obese donors is safe and feasible with good postoperative outcomes. There were no significant differences regarding postoperative outcome between hand-assisted retroperitoneoscopic and laparoscopic donor nephrectomy. Furthermore, the outcome in donors with body mass index ≥ 35 was comparable to donors with body mass index 30-35.

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Section: Discussionmentioning

confidence: 99%

Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy

et al. 2019

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“…Additionally, delayed graft function is more common after donation from people with obesity ( 170 ). Locke et al investigated long-term mortality rates in nearly 120,000 living kidney donors with obesity in the United States over 10.7-year median follow-up ( 171 ). Obesity increased the relative risk of 20-year mortality by 30% compared with non-obese donors, and although absolute risk of post-donation mortality was low, these findings justify the caution exerted by transplant centres in limiting kidney donation by obese individuals.…”

Section: What Is the Role Of Metabolic Surgery In People With End-stamentioning

confidence: 99%

Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions?

et al. 2020

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Obesity is a major factor in contemporary clinical practice in nephrology. Obesity accelerates the progression of both diabetic and non-diabetic chronic kidney disease and, in renal transplantation, both recipient and donor obesity increase the risk of allograft complications. Obesity is thus a major driver of renal disease progression and a barrier to deceased and living donor kidney transplantation. Large observational studies have highlighted that metabolic surgery reduces the incidence of albuminuria, slows chronic kidney disease progression, and reduces the incidence of end-stage kidney disease over extended follow-up in people with and without type 2 diabetes. The surgical treatment of obesity and its metabolic sequelae has therefore the potential to improve management of diabetic and non-diabetic chronic kidney disease and aid in the slowing of renal decline toward end-stage kidney disease. In the context of patients with end-stage kidney disease, although complications of metabolic surgery are higher, absolute event rates are low and it remains a safe intervention in this population. Pre-transplant metabolic surgery increases access to kidney transplantation in people with obesity and end-stage kidney disease. Metabolic surgery also improves management of metabolic complications post-kidney transplantation, including new-onset diabetes. Procedure selection may be critical to mitigate the risks of oxalate nephropathy and disruption to immunosuppressant pharmacokinetics. Metabolic surgery may also have a role in the treatment of donor obesity, which could increase the living kidney donor pool with potential downstream impact on kidney paired exchange programmes. The present paper provides a comprehensive coverage of the literature concerning renal outcomes in clinical studies of metabolic surgery and integrates findings from relevant mechanistic pre-clinical studies. In so doing the key unanswered questions for the field are brought to the fore for discussion.

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“…Possible longer-term increased risk of ESKD and mortality. [ 45 – 55 ] Black race Higher relative risk of hypertension, CKD and ESKD. Increased risk of gout.…”

Section: Discussionmentioning

confidence: 99%

“…More recently, the same group has reported the risk of mortality in the same kidney donor population [ 55 ]. They found the estimated risk of mortality in obese donors to be 304 per 10,000 and 209 per 10,000 in non-obese living kidney donors.…”

Section: Special Considerationsmentioning

confidence: 99%

One size does not fit all: understanding individual living kidney donor risk

Asgari

Hilton

2020

Pediatr Nephrol

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Living donor kidney transplantation is the optimal treatment for end-stage kidney disease (ESKD) but confers a risk upon the donor, both in the short term and many years after donation. While perioperative mortality is low and longevity does not appear to be adversely affected, there are small increases in the risk of other important morbidities. The overall risk of ESKD among donors is low but appears to be three-to five-fold higher than among healthy non-donors, and this relative risk is even higher among donors of African ancestry. For these individuals, apolipoprotein L1 genotyping may be helpful. Kidney donors also have an increased risk of developing hypertension post-donation and a modestly increased risk of developing gout. Living kidney donation also increases the risk of gestational hypertension and preeclampsia while not affecting other important pregnancy outcomes. As our understanding of donor risk grows, it is important to counsel prospective donors according to their individual risk and so obtain better informed donor consent. As knowledge advances, it is also important that all clinicians who manage kidney transplant candidates have an up to date understanding of donor risk to inform shared decision making.

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Obesity and long-term mortality risk among living kidney donors

Cited by 32 publications

References 28 publications

Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy

Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy

Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions?

One size does not fit all: understanding individual living kidney donor risk

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