Outcomes of Renal Transplantation in Obese Recipients

Bardonnaud, N.; Pillot, P.; Lillaz, J.; Delorme, G.; Chabannes, É.; Bernardini, S.; Guichard, G.; Bittard, Hugues; Kleinclauss, F.

doi:10.1016/j.transproceed.2012.09.031

Cited by 53 publications

(46 citation statements)

References 27 publications

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“…The hazard ratio (HR) for the presence of BPAR in obese recipients was calculated to be 1.51 (95% confidence interval [CI], 1.24-1.78). 23,26,29,30,37,40,41 Our evaluation showed that obese recipients had a significantly greater risk of BPAR after renal transplant (hetero geneity, I 2 = 17%; P < .01).…”

Section: Biopsy-proven Acute Rejectionmentioning

confidence: 73%

“…45 In comparison with healthy renal transplant recipients (BMI of 18.5-24.9 kg/m 2 ), obese renal transplant recipients had an HR of developing type 2 diabetes mellitus of 1.01 (95% CI, 0.98-1.07). 22,25,31,37,41 These results indicate essentially no statistically significant difference in the risks of developing type 2 diabetes mellitus between healthy transplant recipients and obese transplant recipients (heterogeneity, 74%; P < .01).…”

Section: Allograft Lossmentioning

confidence: 87%

“…[23][24][25][26][27][28][29][30][35][36][37][38][39][40] The 14 studies assessed 63 383 patients. Patient death was defined to include cessation of heartbeat, cessation of respiratory system, and complete loss of brain activity.…”

Section: Patient Deathmentioning

confidence: 99%

“…21,23,[30][31][32][33][34][35][36][37][38][39][40] The 13 studies assessed 48 719 patients. Allograft loss was defined in accordance with the journal Kidney International as "either the need to re-transplant, resume chronic hemodialysis, or undergo a nephrectomy.…”

Section: Allograft Lossmentioning

confidence: 99%

“…43 The HR for allograft loss in obese recipients was 1.54 (95% CI, 1.38-1.68). 21,23,[30][31][32][33][34][35][36][37][38][39][40] This HR represents statistically significant evidence of greater allograft loss in obese transplant recipients (heterogeneity, I 2 = 3%; P = .49). 45 In comparison with healthy renal transplant recipients (BMI of 18.5-24.9 kg/m 2 ), obese renal transplant recipients had an HR of developing type 2 diabetes mellitus of 1.01 (95% CI, 0.98-1.07).…”

Section: Allograft Lossmentioning

confidence: 99%

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Untitled

2016

Exp Clin Transplant

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Objectives: The prevalence of obesity is increasing rapidly and globally, yet systemic reviews on this topic are scarce. Our meta-analysis and systemic review aimed to assess how obesity affects 5 postoperative outcomes: biopsy-proven acute rejection, patient death, allograft loss, type 2 diabetes mellitus after transplant, and delayed graft function. Materials and Methods: We evaluated peer-reviewed literature from 22 medical databases. Studies were included if they were conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology criteria, only examined postoperative outcomes in adult patients, only examined the relation between recipient obesity at time of transplant and our 5 postoperative outcomes, and had a minimum score of > 5 stars on the Newcastle-Ottawa scale for nonrandomized studies. Reliable conclusions were ensured by having our studies examined against 2 internationally known scoring systems. Obesity was defined in accordance with the World Health Organization as having a body mass index of > 30 kg/m 2 . All obese recipients were compared versus "healthy" recipients (body mass index of 18.5-24.9 kg/m 2 ). Hazard ratios were calculated for biopsy-proven acute rejection, patient death, allograft loss, and type 2 diabetes mellitus after transplant. An odds ratio was calculated for delayed graft function. Results: We assessed 21 retrospective observational studies in our meta-analysis (N = 241 381 patients). In obese transplant recipients, hazard ratios were 1.51 (95% confidence interval, 1.24-1.78) for presence of biopsy-proven acute rejection, 1.19 (95% confidence interval, 1.10-1.31) for patient death, 1.54 (95% confidence interval, 1.38-1.68) for allograft loss, and 1.01 (95% confidence interval, 0.98-1.07) for development of type 2 diabetes mellitus. The odds ratio for delayed graft function was 1.81 (95% confidence interval, 1.51-2.13). Conclusions: Our meta-analysis clearly demonstrated greater risks for obese renal transplant recipients and poorer postoperative outcomes with obesity. We confidently recommend renal transplant candidates seek medically supervised weight loss before transplant.

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Section: Biopsy-proven Acute Rejectionmentioning

confidence: 73%

Section: Allograft Lossmentioning

confidence: 87%

Section: Patient Deathmentioning

confidence: 99%

Section: Allograft Lossmentioning

confidence: 99%

Section: Allograft Lossmentioning

confidence: 99%

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Untitled

2016

Exp Clin Transplant

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Association of Body Mass Index With Infectious Complications in Free Tissue Transfer for Head and Neck Reconstructive Surgery

Khan

Russo

Spivack

et al. 2017

JAMA Otolaryngol Head Neck Surg

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Robot‐assisted kidney transplantation is a safe alternative approach for morbidly obese patients with end‐stage renal disease

Lee

Rawashdeh

McCracken

et al. 2021

Robotics Computer Surgery

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Background: Many centres deny obese patients with a body mass index (BMI) >35 access to kidney transplantation due to increased intraoperative and postoperative complications. Methods: From August 2017 to December 2019, 73 consecutive cases of kidney transplantation in morbidly obese patients were enrolled at a single university at the initiation of a robotic transplant surgery program. Outcomes of patients who underwent robotic assisted kidney transplant (RAKT) were compared to frequencymatched patients undergoing open kidney transplant (OKT).Results: A total of 24 morbidly obese patients successfully underwent RAKT, and 49 obese patients received an OKT. The RAKT group developed fewer surgical site infections (SSI) than the OKT group. Graft function, creatinine, and glomerular filtration rate (GFR) were similar between groups 1 year after surgery. Graft and patient survival were 100% for both groups.Conclusions: RAKT offers a safe alternative for morbidly obese patients, who may otherwise be denied access to OKT.

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Outcomes of Renal Transplantation in Obese Recipients

Cited by 53 publications

References 27 publications

Untitled

Untitled

Association of Body Mass Index With Infectious Complications in Free Tissue Transfer for Head and Neck Reconstructive Surgery

Robot‐assisted kidney transplantation is a safe alternative approach for morbidly obese patients with end‐stage renal disease

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