Obesity Was Associated With Inferior Outcomes in Simultaneous Pancreas Kidney Transplant

Abstract

BACKGROUND.: In kidney transplant, obesity was reported to be associated with increased posttransplant complications and worse survival outcomes. The impact of obesity in simultaneous pancreas-kidney (SPK) transplant is less known. METHODS.: Using Organ Procurement Transplantation Network/United Network for Organ Sharing data as of August 2008, we included all adults (>18 years) type 1 diabetic SPK recipients between years 2000 and 2007 with a pretransplant body mass index (BMI) of 18.5 to 40 kg/m. The cohort was divided in three groups: normal (BMI 18.5-24.9 kg/m, reference group), overweight (BMI 25-29.9 kg/m), and obese (BMI 30-40 kg/m). Covariate-adjusted relative risk of a combination of posttransplant complications and patient, pancreas and kidney allograft outcomes were evaluated. RESULTS.: Of 5725 recipients, 56%, 33%, and 11% were in normal, overweight, and obese groups, respectively. Overweight and obese recipients were older, had a higher percent of coronary artery disease, and private health insurance coverage. Overall posttransplant complications were higher in obese group (35.7% vs. 28.6%) when compared with normal BMI group. They were mainly due to increased delayed kidney graft function (11.8% vs. 7.4%), 1-year kidney acute rejection (17.0% vs. 12.1%), and pancreas graft thrombosis (2.6% vs. 1.3%). After adjusting for possible confounders, the odds ratios for overall transplant complications were 1.03 (95% confidence interval [CI]: 0.90-1.17) for overweight and 1.38 (95% CI: 1.15-1.68) for obese. Obesity, but not overweight, was associated with patient death (hazard ratio [HR]: 1.35; 95% CI: 1.00-1.81), pancreas graft loss (HR: 1.41; 95% CI: 1.17-1.69), and kidney graft loss (HR: 1.33; 95% CI: 1.05-1.67) at 3 years. The higher rates of death and graft failure in the first 30 days posttransplant mostly accounted for the 3-year survival differences. CONCLUSION.: Obesity in SPK recipients was associated with increased risk of posttransplant complications, pancreas and kidney graft loss, and patient death.

Outcomes of Simultaneous Pancreas-Kidney Transplantation in Type 2 Diabetic Recipients

“…Risks for kidney and pancreas failure in overall insulin-dependent recipients were most importantly associated with AA race (versus Caucasian) and obesity (versus normal BMI). This was not a surprise because AA race was associated with increased risk of nonimmune and immune posttransplant complications (27), and obesity has been shown to be a potential risk for posttransplant complications in T1DM (28). In nontransplant surgery, obese patients were more likely to have increased surgical time and blood loss during the procedure (29,30).…”

Long-term Effects of Delayed Graft Function on Pancreas Graft Survival After Pancreas Transplantation

“…Sampaio et al (16) demonstrated that obesity in SPK recipients was found to be associated with an increased risk of posttransplant complications, pancreas and kidney graft loss, and patient death. They reported that poor outcomes in obese group were mainly caused by increased rates of delayed kidney graft function, 1-year kidney acute rejection, and pancreas graft thrombosis in obese recipients in comparison with normal recipients.…”

Surgical Morbidity of Simultaneous Kidney and Pancreas Transplantation: A Single-Centre Experience in the Tacrolimus Era

“…Large series have documented thrombosis to be responsible for the majority of technical failures and early gra loss [4,23]. Factors that have been shown to predispose to gra thrombosis include recipient obesity, preservation time, and nontraumatic causes of donor death [4,24].…”