Study of weight and body mass index on graft loss after transplant over 5 years of evolution

Abstract

Patients frequently experience a weight gain after organ transplantation. This increase in weight is the result of multiple factors, and is usually intensified by glucocorticoids and immunosuppressive drugs. It can also delay graft function and cause serious health problems. The objective of this study was to study the obesity as well as its causes and consequences in kidney transplant patients. The sample population consisted of 282 renal transplant patients, 170 men and 112 women, 18-74 years of age, who were monitored over a period of five years. For the purposes of our research, the patients were divided into two groups: (1) normal weight 18.5 ≤ BMI <25; (2) overweight 25 ≤ BMI ≤30. The association between BMI as an independent variable and graft survival was determined by means of a Cox regression analysis. Overweight patients were characterized by a higher comorbidity prevalence. In the Cox multivariate analysis, the initial BMI, evaluated as a continuous variable continued to be an independent predictor of delayed graft function and chronic nephropathy. This study evaluated the BMI as a continuous value instead of a categorical value. In conclusion, our results suggest that an increase in BMI without categorical variation can be an independent risk factor for graft loss. Consequently, obesity prevention for renal transplant patients should include dietary counseling and management, moderate physical activity, and steroid minimization.

Safety and utility of panniculectomy in renal transplant candidates and end stage renal disease patients

“…Previous studies comparing individuals with obesity and those with BMIs below 30 kg/m 2 have reported increased incidence of delayed graft function, higher rates of acute rejection, graft failure, and proteinuria in patients with higher BMIs. [24][25][26] Though yet to be validated in RT, there are several mechanisms that may elucidate the deleterious effect of obesity on graft outcomes. Firstly, obesity may worsen outcomes due to the pro-inflammatory nature of adipose tissue, which has been found to accelerate rejection pathways in lung grafts.…”

“…Graft survival is of utmost importance in the context of renal transplantation. Previous studies comparing individuals with obesity and those with BMIs below 30 kg/m 2 have reported increased incidence of delayed graft function, higher rates of acute rejection, graft failure, and proteinuria in patients with higher BMIs 24–26 . Though yet to be validated in RT, there are several mechanisms that may elucidate the deleterious effect of obesity on graft outcomes.…”

Beneficial effects of physical exercise on the osteo-renal Klotho-FGF-23 axis in Chronic Kidney Disease: A systematic review with meta-analysis

“…The main cause of mortality in CKD is cardiovascular (CV), with an increase in cardiovascular risk (CVR) 20 times higher than in the general population 3 . It is estimated that approximately 11% of stage 3 CKD cases will progress to end-stage renal disease (ESRD) and eventually require dialysis or kidney transplantation 4 . Eighty percent of patients with CKD present cardiovascular events, including arterial hypertension (36%), ischemic heart disease (22-39%), heart failure (20-40%), atrial fibrillation (30%), valvular heart disease (24%) and left ventricular hypertrophy (LVH), which occurs in 50-75% of patients with stage 3 or 4 CKD 5 .…”

Losing Weight; The Experience of Patients With End Stage Kidney Disease: A Qualitative Study

“…Recipients tend to gain weight up to 10 kg post-transplant. The post-transplant weight gain is the result of multiple factors, and is usually intensi ed by glucocorticoids and immunosuppressive drugs [5]. A pre-transplant (BMI) > 30 kg/m 2 along with post-transplant immunosuppression increase the risk of new-onset diabetes after transplantation [6], and increasing BMI > 30 kg/m 2 is associated with greater risk of graft loss.…”