Recipient obesity as a risk factor in kidney transplantation

Uwe Scheuermann; Jonas Babel; Uta-Carolin Pietsch; Antje Weimann; Orestis Lyros; Katrin Semmling; Hans-Michael Hau; Daniel Seehofer; Sebastian Rademacher; Robert Sucher

doi:10.1186/s12882-022-02668-z

Recipient obesity as a risk factor in kidney transplantation

BMC Nephrol. 2022 Jan 18;23(1):37. doi: 10.1186/s12882-022-02668-z.

Authors

Affiliations

¹ Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany. uwe.scheuermann@medizin.uni-leipzig.de.
² Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
³ Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany.
⁴ Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.

^# Contributed equally.

Abstract

Background: The aim of the study was to investigate the effect of recipient obesity on the short- and long-term outcomes of patients undergoing primary kidney transplantation (KT).

Patients and methods: A total of 578 patients receiving primary KT in our department between 1993 and 2017 were included in the study. Patients were divided according to their body mass index (BMI) into normal weight (BMI 18.5-24.9 kg/m²; N = 304), overweight (BMI 25-29.9 kg/m²; N = 205) and obese (BMI ≥ 30 kg/m²; N = 69) groups. Their clinicopathological characteristics, outcomes, and survival rates were analyzed retrospectively.

Results: Obesity was associated with an increased rate of surgical complications such as wound infection (P < 0.001), fascial dehiscence (P = 0.023), and lymphoceles (P = 0.010). Furthermore, the hospital stay duration was significantly longer in the groups with obese patients compared to normal weight and overweight patients (normal weight: 22 days, overweight: 25 days, and obese: 33 days, respectively; P < 0.001). Multivariate analysis showed that recipient obesity (BMI ≥ 30) was an independent prognostic factor for delayed graft function (DGF) (OR 2.400; 95% CI, 1.365-4.219; P = 0.002) and postoperative surgical complications (OR 2.514; 95% CI, 1.230-5.136; P = 0.011). The mean death-censored graft survival was significantly lower in obese patients (normal weight: 16.3 ± 0.6 years, overweight: 16.3 ± 0.8 years, obese 10.8 ± 1.5 years, respectively; P = 0.001). However, when using the Cox proportional hazards model, the association between recipient obesity and death-censored renal graft failure disappeared, after adjustment for important covariates, whereas the principal independent predictors of graft loss were recipient diabetes mellitus and hypertension and kidneys from donors with expanded donor criteria.

Conclusion: In conclusion, obesity increases the risk of DGF and post-operative surgical complications after primary KT. Appropriate risk-adapted information concerning this must be provided to such patients before KT. Furthermore, obesity-typical concomitant diseases seem to negatively influence graft survival and need to be considered after the transplantation of obese patients.

Keywords: Body mass index; Kidney transplantation; Obesity; Outcome; Survival.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Humans
Kidney Transplantation*
Male
Middle Aged
Obesity / complications*
Postoperative Complications / etiology*
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome