|
1
|
Zahran MH, Khewater T, Ayyad M, Ali A, Ghazi M, Serageldeen A, Omar A, Aljohni ZS, Albalawi W, Fourtounas K, Adi H. Bariatric Surgery as a Bridge for Renal Transplantation. An Age and BMI-Matched Pair Analysis. Transplant Proc 2025:S0041-1345(25)00205-2. [PMID: 40312211 DOI: 10.1016/j.transproceed.2025.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Accepted: 03/16/2025] [Indexed: 05/03/2025]
Abstract
BACKGROUND Morbid obesity is a relative contraindication for renal transplantation (RT) and associated with increased perioperative complications and compromised graft survival. We aimed at evaluating the safety of bariatric surgery (BS) in patients with end-stage renal disease (ESRD) and its efficacy on improving access to RT and to compare RT outcomes to an age- and body mass index (BMI)-matched group. METHODS This is a case-control study including eight patients with ESRD who underwent BS as a bridge before RT (group I). The primary outcome was to assess the safety and efficacy of BS. The secondary outcome was to assess the impact on RT outcomes, surgical complications, and long-term graft survival. The third outcome was to compare them to an age- and BMI-matched control group (group II, 16 patients). RESULTS In group I, the median (IQR) BMI decreased from 41 (38-45) to 31 (28-33) kg/m2 (P = .01) with absolute percent reduction of 24% after BS. Five out of seven patients with diabetes (71%) stopped taking insulin medication (P = .03). All patients with hypertension decreased their medications to a single drug (P = 0.03). Five patients (63%) underwent RT after 25 (5-45) months. All were discharged with functioning grafts with median serum creatinine of 81 (60-90) mmol/L and estimated glomerular filtration rate (eGFR) of 79 (61-91) mL/min/1.73m2. One patient (20%) was reoperated for wound infection. After follow-up of 31 (8-62) months, all patients have a functioning graft. No statistically significant differences were identified between both groups in regard to post-operative complications and graft function at discharge and at the last follow-up (P > .05). CONCLUSIONS BS is safe and effective in pre-transplant patients with obesity and associated with comparable RT outcomes to those without a history of BS.
Collapse
Affiliation(s)
- Mohamed H Zahran
- Prince Sultan Kidney Center, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia; Urology Department, Urology and Nephrology Center, Mansoura University, Egypt.
| | - Talal Khewater
- Laparoscopic & Bariatric Surgery Center, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia
| | - Mostafa Ayyad
- Prince Sultan Kidney Center, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia
| | - Ahmed Ali
- Prince Sultan Kidney Center, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia
| | - Mojahed Ghazi
- Laparoscopic & Bariatric Surgery Center, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia
| | - Ahmed Serageldeen
- Prince Sultan Kidney Center, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia; Nephrology Unit, Internal Medicine Department, Ain Shams University, Egypt
| | - Alaaelden Omar
- Prince Sultan Kidney Center, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia
| | - Zayed S Aljohni
- Prince Sultan Kidney Center, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia
| | - Waad Albalawi
- Prince Sultan Kidney Center, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia
| | - Konstantinos Fourtounas
- Prince Sultan Kidney Center, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia
| | - Hussam Adi
- Laparoscopic & Bariatric Surgery Center, King Salman Armed Forces Hospital, Tabuk, Kingdom of Saudi Arabia
| |
Collapse
|
|
2
|
Benes B, Langewisch ED, Westphal SG. Kidney Transplant Candidacy: Addressing Common Medical and Psychosocial Barriers to Transplant. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:387-399. [PMID: 39232609 DOI: 10.1053/j.akdh.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 09/06/2024]
Abstract
Improving access to kidney transplants remains a priority for the transplant community. However, many medical, psychosocial, geographic, and socioeconomic barriers exist that prevent or delay transplantation for candidates with certain conditions. There is a lack of consensus regarding how to best approach many of these issues and barriers, leading to heterogeneity in transplant centers' management and acceptance practices for a variety of pretransplant candidate issues. In this review, we address several of the more common contemporary patient medical and psychosocial barriers frequently encountered by transplant programs. The barriers discussed here include kidney transplant candidates with obesity, older age, prior malignancy, cardiovascular disease, history of nonadherence, and cannabis use. Improving understanding of how to best address these specific issues can empower referring providers, transplant programs, and patients to address these issues as necessary to progress toward eventual successful transplantation.
Collapse
Affiliation(s)
- Brian Benes
- Nephrology Division, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Eric D Langewisch
- Nephrology Division, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Scott G Westphal
- Nephrology Division, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
| |
Collapse
|
|
3
|
Kanbay M, Guldan M, Ozbek L, Copur S, Covic AS, Covic A. Exploring the nexus: The place of kidney diseases within the cardiovascular-kidney-metabolic syndrome spectrum. Eur J Intern Med 2024; 127:1-14. [PMID: 39030148 DOI: 10.1016/j.ejim.2024.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/25/2024] [Accepted: 07/11/2024] [Indexed: 07/21/2024]
Abstract
Cardiovascular-kidney-metabolic (CKM) syndrome and chronic kidney disease (CKD) are two significant comorbidities affecting a large proportion of the general population with considerable crosstalk. In addition to substantial co-incidence of CKD and CKM syndrome in epidemiological studies, clinical and pre-clinical studies have identified similar pathophysiological pathways leading to both entities. Patients with CKM syndrome are more prone to develop acute kidney injury and CKD, while therapeutic alternatives and their success rates are considerably lower in such patient groups. Nevertheless, the association between CKM syndrome and CKD or ESKD is bidirectional rather than being a cause-effect relationship as patients with CKD are also prone to develop peripheral insulin resistance, high blood pressure, and dyslipidemia. Furthermore, such patients are less likely to receive kidney transplantation in addition to the higher allograft dysfunction risk. We hereby aim to evaluate the association in-between kidney diseases and CKM syndrome, including epidemiological data, pre-clinical studies with pathophysiological pathways, and potential therapeutic perspectives.
Collapse
Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
| | - Mustafa Guldan
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Lasin Ozbek
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Division of Internal Medicine, Koç University School of Medicine, Istanbul, Turkey
| | | | - Adrian Covic
- University of Medicine "Grigore T Popa" Iasi, Romania
| |
Collapse
|
|
4
|
Alasfar S, Me HM, Budhiraja P. Approach to Late Noninfectious Post-Transplant Complications. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:436-449. [PMID: 39232614 DOI: 10.1053/j.akdh.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/16/2024] [Accepted: 05/24/2024] [Indexed: 09/06/2024]
Abstract
The management of noninfectious complications in kidney transplant recipients includes a broad spectrum of conditions, including metabolic issues, cardiovascular diseases, and malignancies, each presenting unique challenges for nephrologists managing these patients. Unlike infectious complications, these noninfectious issues require nuanced, multidisciplinary approaches for prevention, diagnosis, and management, emphasizing the need for personalized care plans. Cardiovascular disease is particularly significant, standing as the primary cause of death post-transplantation, with recent data indicating an overtaking of cancer death rates over infections among kidney transplant recipients. The intricacies of managing these patients, influenced by the burden of kidney disease and immunosuppression, highlight the importance of a collaborative care model. Although nephrologists may not directly treat all these conditions, their understanding of the unique aspects of transplant recipients is crucial. They play a pivotal role in coordinating care with specialists such as cardiologists, endocrinologists, hematologists, and oncologists, ensuring comprehensive management that addresses these specific post-transplant complications. This review discusses the epidemiology, underlying mechanisms, clinical manifestations, and management strategies of various noninfectious complications post-kidney transplant, with a focus on cardiovascular, metabolic, oncologic, and hematologic complications.
Collapse
Affiliation(s)
- Sami Alasfar
- Mayo Clinic Arizona, Division of Nephrology, Department of Medicine, Phoenix, AZ.
| | - Hay Me Me
- Mayo Clinic Arizona, Division of Nephrology, Department of Medicine, Phoenix, AZ
| | - Pooja Budhiraja
- Mayo Clinic Arizona, Division of Nephrology, Department of Medicine, Phoenix, AZ
| |
Collapse
|
|
5
|
Marzorati S, Iovino D, Inversini D, Iori V, Parise C, Masci F, Liepa L, Oltolina M, Zani E, Franchi C, Morabito M, Gritti M, Di Bella C, Bisogno S, Mangano A, Tozzi M, Carcano G, Ietto G. Open Renal Transplantation in Obese Patients: A Correlation Study between BMI and Early and Late Complications with Implementation of a Prognostic Risk Score. Life (Basel) 2024; 14:915. [PMID: 39063668 PMCID: PMC11278128 DOI: 10.3390/life14070915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/18/2024] [Accepted: 07/19/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Obesity is a global epidemic that affects millions worldwide and can be a deterrent to surgical procedures in the population waiting for kidney transplantation. However, the literature on the topic is controversial. This study evaluates the impact of body mass index (BMI) on complications after renal transplantation, and identifies factors associated with major complications to develop a prognostic risk score. METHODS A correlation analysis between BMI and early and late complications was first performed, followed by a univariate and multivariate logistic regression analysis. The 302 included patients were divided into obese (BMI ≥ 30 kg/m2) and non-obese (BMI ≤ 30 kg/m2) groups. Correlation analysis showed that delayed graft function (DGF) was the only obesity-associated complication (p = 0.044). Logistic regression analysis identified female sex, age ≥ 57 years, BMI ≥ 25 and ≥30 kg/m2, previous abdominal and/or urinary system surgery, and Charlson morbidity Score ≥ 3 as risk factors for significant complications. Based on the analyzed data, we developed a nomogram and a prognostic risk score. RESULTS The model's area (AUC) was 0.6457 (95% IC: 0.57; 0.72). The percentage of cases correctly identified by this model retrospectively applied to the entire cohort was 73.61%. CONCLUSIONS A high BMI seems to be associated with an increased risk of DGF, but it does not appear to be a risk factor for other complications. Using an easy-to-use model, identification, and stratification of individualized risk factors could help to identify the need for interventions and, thus, improve patient eligibility and transplant outcomes. This could also contribute to maintaining an approach with high ethical standards.
Collapse
Affiliation(s)
- Sara Marzorati
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
| | - Domenico Iovino
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
| | - Davide Inversini
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
- Department of Medicine and Innovation Technology (DiMIT), University of Insubria, 21100 Varese, Italy
| | - Valentina Iori
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
| | - Cristiano Parise
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
| | - Federica Masci
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
| | - Linda Liepa
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
| | - Mauro Oltolina
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
| | - Elia Zani
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
| | - Caterina Franchi
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
| | - Marika Morabito
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
| | - Mattia Gritti
- Department of General Surgery, Humanitas Clinical and Research Center, 20089 Rozzano, Italy;
| | - Caterina Di Bella
- Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, 35128 Padova, Italy;
| | - Silvia Bisogno
- Department of Cardiologic Intensive Care, Hemodynamics and Cardiology, S.M. Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy;
| | - Alberto Mangano
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60607, USA;
| | - Matteo Tozzi
- Vascular Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy;
- Department of Medicine and Surgery (DMC), University of Insubria, 21100 Varese, Italy
| | - Giulio Carcano
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
- Department of Medicine and Innovation Technology (DiMIT), University of Insubria, 21100 Varese, Italy
| | - Giuseppe Ietto
- General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy; (S.M.); (G.C.)
- Department of Medicine and Innovation Technology (DiMIT), University of Insubria, 21100 Varese, Italy
| |
Collapse
|
|
6
|
Prudhomme T, Bento L, Frontczak A, Timsit MO, Boissier R. Effect of Recipient Body Mass Index on Kidney Transplantation Outcomes: A Systematic Review and Meta-analysis by the Transplant Committee from the French Association of Urology. Eur Urol Focus 2024; 10:551-563. [PMID: 37993345 DOI: 10.1016/j.euf.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
CONTEXT The impact of recipient obesity on kidney transplantation (KT) outcomes remains unclear. OBJECTIVE The aim of this study was to perform a systematic review and meta-analysis to appraise all available evidence on the outcomes of KT in obese patients (body mass index [BMI] ≥30 kg/m2) versus nonobese patients (BMI <30 kg/m2). EVIDENCE ACQUISITION A systematic review and meta-analysis was performed. Search was conducted in the MEDLINE OvidSP, Web of Science, Google Scholar, Embase, and Cochrane databases to identify all studies reporting the outcomes of KT in obese versus nonobese recipients. EVIDENCE SYNTHESIS Fifty-two articles met the inclusion criteria. Delayed graft function and surgical complications were significantly higher in obese recipients (delayed graft function: relative risk [RR]: 1.44, 95% confidence interval [CI]: 1.32-1.57, p < 0.01; surgical complications: RR: 1.74, 95% CI: 1.36-2.22, p < 0.0001). Five-year patient survival (RR: 0.96, 95% CI: 0.92-1.00, p = 0.01), 10-yr patient survival (RR: 0.90, 95% CI: 0.84-0.97, p = 0.006), and 10-yr graft survival (RR: 0.87, 95% CI: 0.79-0.96, p = 0.01) were significantly inferior in the obese group. CONCLUSIONS KT in obese recipients was associated with lower patient and graft survival, and higher delayed graft function, acute rejection, and medical and surgical complications than nonobese recipients. In the current situation of organ shortage and increasing prevalence of obesity, ways to optimize KT in this setting should be investigated. PATIENT SUMMARY Compared with nonobese population, kidney transplantation in obese recipients has inferior patient and graft survival, and higher medical and surgical complications.
Collapse
Affiliation(s)
- Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France.
| | - Lucas Bento
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Alexandre Frontczak
- Department of Urology and Kidney Transplantation, Besançon University Hospital, Besançon, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Boissier
- Department of Urology and Kidney Transplantation, Conception University Hospital, Aix-Marseille University, Marseille, France
| |
Collapse
|
|
7
|
Karabulut D, Karabulut U, Kalyoncuoğlu M, Katkat F, Berber İ. Predictive value of triglyceride/glucose index for cardiac outcomes in non-diabetic renal transplant recipients. Acta Cardiol 2024; 79:319-326. [PMID: 37767903 DOI: 10.1080/00015385.2023.2257983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES Insulin resistance (IR) is associated with an increased risk of adverse cardiovascular outcomes. The triglyceride-glucose index (TyG index) is a reliable marker of IR. No study has examined the impact of the TyG index on major adverse cardiac and cerebrovascular events (MACCEs) in RTRs. Therefore, this study aimed to investigate the predictive value of the TyG index for MACCEs in RTRs. MATERIALS AND METHODS Non-diabetic patients undergoing renal transplantation were retrospectively enrolled. The patients were divided into two groups according to MACCE development. The cut-off value of the TyG index for MACCE was conducted. RESULTS The mean age of 522 patients was 41 (31-51) years, and 349 (66.9%) were male. During the 5.4-year follow-up, 84 (16%) MACCE were recorded. TyG index was significantly higher in the group that developed MACCE (p < 0,001). Cox regression analysis revealed that TyG index [HR: 3.297 (1.228-8.855), p = 0.018], left ventricle ejection fraction [HR: 0.934 (0.900-0.968), p < 0.001], cadaveric transplantation [HR: 8.886 (4.764-16.576), p < 0.001], graft survey [HR: 0.608 (0.542-0.682), p < 0.001)], and smoking [HR: 1.965 (1.117-3.456), p = 0.019] were independent predictors of MACCEs in nondiabetic RTRs. CONCLUSION TyG index is an independent predictor of MACCEs in non-diabetic RTRs. The widespread use of the TyG index may positively affect long-term treatment costs and survival.
Collapse
Affiliation(s)
- Dilay Karabulut
- Cardiology Department, Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Umut Karabulut
- Cardiology Department, Acıbadem International Hospital, Istanbul, Turkey
| | - Muhsin Kalyoncuoğlu
- Cardiology Department, Haseki Sultangazi Educational and Research Hospital, Istanbul, Turkey
| | - Fahrettin Katkat
- Cardiology Department, Bağcılar Training and Research Hospital, İstanbul, Turkey
| | - İbrahim Berber
- Cardiology Department, Acıbadem International Hospital, Istanbul, Turkey
| |
Collapse
|
|
8
|
Bosch KD, Harrington C, Sulutaura L, Lacea E, Burton K, Fernandez-Munoz N, Dugal N, Sufi P, Al Midani A, Parmar C. Bariatric Surgery as a Bridge to Facilitate Renal Transplantation in Patients with End-Stage Renal Disease. Obes Surg 2024; 34:355-362. [PMID: 38172424 DOI: 10.1007/s11695-023-06985-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Renal transplantation (RT) is not recommended above BMI 40 kg/m2 as post-operative risks (delayed graft function, wound complications) are increased. Bariatric surgery (BS) results in sustained long-term weight loss. However, renal failure (RF) patients are theoretically higher risk candidates. We aim to investigate the safety of BS in patients with RF and the effect of BS on access to renal transplantation. METHODS We reviewed data from 31 patients with RF referred for BS between 2013 and 2021. We compared the outcomes of patients with RF who underwent BS to those who were referred but did not undergo BS. Controls matched for age/BMI/comorbidity (MC) but without RF were used for comparison. RESULTS Of 31 patients referred, 19 proceeded with BS (68% female, median age 52 years, BMI 46.2 ± 4.9 kg/m2) and 12 did not (58% female, median age 58, mean BMI 41.5 ± 4.1). Excess body weight loss (EBWL) was 71.2% ± 20.2% at 2 years in RF patients versus 66.0% ± 28.0% in MC patients. In the operated group, 11/19 (58%) patients reached their treatment target (six transplanted, five placed on waiting list) versus 3/12 (25%) in unoperated patients (three transplanted). There was no difference in perioperative complications between RF and MC groups. Long-term, there were seven deaths amongst RF patients (two operated, five unoperated), none amongst the MC group. CONCLUSION BS in patients with RF increased access to RT and was safe and effective. We therefore recommend consideration of BS in patients with obesity and RF in specialised units.
Collapse
Affiliation(s)
- Karen D Bosch
- Department of Bariatric Surgery, Whittington Health NHS Trust, London, N19 5NF, UK.
| | - Cuan Harrington
- Department of Surgery, Royal London Hospital, Barts Health NHS Trust, London, E1 1FR, UK
| | - Liene Sulutaura
- Department of Bariatric Surgery, Whittington Health NHS Trust, London, N19 5NF, UK
| | - Emilane Lacea
- Department of Bariatric Surgery, Whittington Health NHS Trust, London, N19 5NF, UK
| | - Katarina Burton
- Department of Bariatric Surgery, Whittington Health NHS Trust, London, N19 5NF, UK
| | | | - Neal Dugal
- National Kidney Transplant Service, Beaumont Hospital, Dublin, D09V2N0, Ireland
| | - Pratik Sufi
- Department of Bariatric Surgery, Whittington Health NHS Trust, London, N19 5NF, UK
| | - Ammar Al Midani
- Department of Renal Transplantation, Royal Free Hospitals NHS Foundation Trust, London, NW3 2QG, UK
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, N19 5NF, UK
- University College London, London, WC1E 6BT, UK
| |
Collapse
|
|
9
|
Lee S, Lee M, Kim YE, Kim HK, Lee SJ, Kim J, Yang Y, Kim CH, Lee H, Joo DJ, Kim MS, Kang ES. Association of Muscle Mass Loss with Diabetes Development in Liver Transplantation Recipients. Diabetes Metab J 2024; 48:146-156. [PMID: 38173368 PMCID: PMC10850281 DOI: 10.4093/dmj.2022.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 02/27/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGRUOUND Post-transplant diabetes mellitus (PTDM) is one of the most significant complications after transplantation. Patients with end-stage liver diseases requiring transplantation are prone to sarcopenia, but the association between sarcopenia and PTDM remains to be elucidated. We aimed to investigate the effect of postoperative muscle mass loss on PTDM development. METHODS A total of 500 patients who underwent liver transplantation at a tertiary care hospital between 2005 and 2020 were included. Skeletal muscle area at the level of the L3-L5 vertebrae was measured using computed tomography scans performed before and 1 year after the transplantation. The associations between the change in the muscle area after the transplantation and the incidence of PTDM was investigated using a Cox proportional hazard model. RESULTS During the follow-up period (median, 4.9 years), PTDM occurred in 165 patients (33%). The muscle mass loss was greater in patients who developed PTDM than in those without PTDM. Muscle depletion significantly increased risk of developing PTDM after adjustment for other confounding factors (hazard ratio, 1.50; 95% confidence interval, 1.23 to 1.84; P=0.001). Of the 357 subjects who had muscle mass loss, 124 (34.7%) developed PTDM, whereas of the 143 patients in the muscle mass maintenance group, 41 (28.7%) developed PTDM. The cumulative incidence of PTDM was significantly higher in patients with muscle loss than in patients without muscle loss (P=0.034). CONCLUSION Muscle depletion after liver transplantation is associated with increased risk of PTDM development.
Collapse
Affiliation(s)
- Sejeong Lee
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Minyoung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Eun Kim
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hae Kyung Kim
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sook Jung Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jiwon Kim
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yurim Yang
- Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Hoon Kim
- Department of Pharmacology, Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Korea
| | - Hyangkyu Lee
- Mo-Im Kim Nursing Research Institute, Biobehavioral Research Center, Yonsei University College of Nursing, Seoul, Korea
| | - Dong Jin Joo
- Division of Transplantation, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Myoung Soo Kim
- Division of Transplantation, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Seok Kang
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
|
10
|
Shakhshir MH, Vanoh D, Hassan M, Zyoud SH. Mapping the global research landscape on malnutrition for patients with chronic kidney disease: a visualization analysis. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:101. [PMID: 37742012 PMCID: PMC10517565 DOI: 10.1186/s41043-023-00445-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/15/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is seen as a diverse disease and a primary contributor to global mortality. Malnutrition arises within chronic illness, which involves protein energy depletion and inadequate levels of essential nutrients. These factors increase the likelihood of death and the overall impact of the disease on affected individuals. Consequently, this study aims to utilize bibliometric and visual analysis to assess the current state of research, the latest advances and emerging patterns in the fields of CKD and malnutrition. METHODS Extensive research was conducted using the Scopus database, which is the most authoritative database of research publications and citations, to focus on CKD research between 2003 and 2022, as indicated by title and author keywords. Then, within this vast collection of academic publications, a notable subset of articles was exclusively dedicated to investigating the relationship between CKD and malnutrition. Finally, we performed bibliometric analysis and visualization using VOSviewer 1.6.19 and Microsoft Excel 2013. RESULTS Large global research between 2003 and 2022 resulted in 50,588 documents focused on CKD, as indicated by title and author keywords. In this extensive collection of scientific publications, a staggering portion of 823 articles is devoted exclusively to investigating the link between CKD and malnutrition. Further analysis reveals that this body of work consists of 565 articles (68.65%), 221 reviews (26.85%), and 37 miscellaneous entries (4.50%), which encompass letters and editorials. The USA was found to be the most productive country (n = 173; 21.02%), followed by Italy (n = 83; 10.09%), Sweden (n = 56; 6.80%), Brazil (n = 54; 6.56%) and China (n = 51; 6.20%). The most common terms on the map include those related to the topic of (a) malnutrition in hemodialysis patients and predicting factors; terms associated with the (b) impact of malnutrition on cardiovascular risk and complications in CKD patients; and terms related to the (c) dietary protein intake and malnutrition in CKD. CONCLUSIONS This study is the first of its kind to analyze CKD and malnutrition research using data from Scopus for visualization and network mapping. Recent trends indicate an increasing focus on protein-energy wasting/malnutrition in hemodialysis patients and predicting factors, dietary protein intake, and malnutrition in CKD. These topics have gained significant attention and reflect the latest scientific advances. Intervention studies are crucial to examining diet therapy's impact on patients with stages 1 to 5 CKD. We hope this study will offer researchers, dietitians and nephrologists valuable information.
Collapse
Affiliation(s)
- Muna H Shakhshir
- Department of Nutrition, An-Najah National University Hospital, Nablus, 44839, Palestine.
- Department of Public Health, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Dietetics Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Health Campus, 16150, Kubang Kerian, Malaysia.
| | - Divya Vanoh
- Dietetics Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Health Campus, 16150, Kubang Kerian, Malaysia.
| | - Mohanad Hassan
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Nephrology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Clinical Research Centre, An-Najah National University Hospital, Nablus, 44839, Palestine
| |
Collapse
|
|
11
|
Jethwani P. Overview of Renal Transplantation for Primary Care Physicians: Workup, Complications, and Management. Med Clin North Am 2023; 107:707-716. [PMID: 37258008 DOI: 10.1016/j.mcna.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Kidney transplantation remains the treatment of choice for eligible patients with end-stage kidney disease. The last few decades have seen an expansion in the transplant recipient pool with over 250,000 patients living with a kidney transplant today. Because of limited bandwidth for ongoing follow-up and management of chronic medical conditions, transplant centers are directing more and more patients back to their general nephrologists and primary care doctors for longitudinal care. As a result, it is becoming increasingly important for primary care physicians to have a nuanced understanding of medications, complications, and chronic medical problems unique to transplant recipients. This article reviews the role of the primary care office in helping streamline the pretransplant evaluation process and long-term posttransplant care.
Collapse
Affiliation(s)
- Priyanka Jethwani
- James D Eason Transplant Institute, Methodist University Hospital, 1265 Union Avenue, Memphis, TN 38104, USA; Department of Surgery, University of Tennessee Health Sciences Center, 1211 Union Avenue, Memphis, TN 38104, USA.
| |
Collapse
|
|
12
|
Shi B, Ying T, Xu J, Wyburn K, Laurence J, Chadban SJ. Obesity is Associated With Delayed Graft Function in Kidney Transplant Recipients: A Paired Kidney Analysis. Transpl Int 2023; 36:11107. [PMID: 37324221 PMCID: PMC10261700 DOI: 10.3389/ti.2023.11107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/11/2023] [Indexed: 06/17/2023]
Abstract
Obesity is increasingly prevalent among candidates for kidney transplantation. Existing studies have shown conflicting post-transplant outcomes for obese patients which may relate to confounding bias from donor-related characteristics that were unaccounted for. We used ANZDATA Registry data to compare graft and patient survival between obese (BMI >27.5 kg/m2 Asians; >30 kg/m2 non-Asians) and non-obese kidney transplant recipients, while controlling for donor characteristics by comparing recipients of paired kidneys. We selected transplant pairs (2000-2020) where a deceased donor supplied one kidney to an obese candidate and the other to a non-obese candidate. We compared the incidence of delayed graft function (DGF), graft failure and death by multivariable models. We identified 1,522 pairs. Obesity was associated with an increased risk of DGF (aRR = 1.26, 95% CI 1.11-1.44, p < 0.001). Obese recipients were more likely to experience death-censored graft failure (aHR = 1.25, 95% CI 1.05-1.49, p = 0.012), and more likely to die with function (aHR = 1.32, 95% CI 1.15-1.56, p = 0.001), versus non-obese recipients. Long-term patient survival was significantly worse in obese patients with 10- and 15-year survival of 71% and 56% compared to 77% and 63% in non-obese patients. Addressing obesity is an unmet clinical need in kidney transplantation.
Collapse
Affiliation(s)
- Bree Shi
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, SA, Australia
| | - Tracey Ying
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, SA, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Josephine Xu
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, SA, Australia
- Department of Transplant Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Kate Wyburn
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, SA, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jerome Laurence
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, SA, Australia
- Department of Transplant Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Steven J Chadban
- Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australia Health and Medicine Research Institute, Adelaide, SA, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| |
Collapse
|
|
13
|
Tsapepas D, Sandra V, Dale LA, Drexler Y, King KL, Yu M, Toma K, Van Bever J, Sanichar N, Husain SA, Mohan S. Retrospective analysis of the impact of severe obesity on kidney transplant outcomes. Nephrol Dial Transplant 2023; 38:472-480. [PMID: 35524689 DOI: 10.1093/ndt/gfac169] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevalence of obesity among kidney transplant recipients is rising. We sought to determine the association between recipient body mass index (BMI) and post-transplant complications. METHODS Single-center, retrospective cohort study of all adult kidney transplant recipients from 2004 to 2020. Recipients were stratified into four BMI categories: normal-weight (BMI 18.5-24.9 kg/m2, n = 1020), overweight (BMI 25-29.9 kg/m2, n = 1002), moderately obese (BMI 30-34.9 kg/m2, n = 510) and severely-to-morbidly obese (BMI ≥35 kg/m2, n = 274). Logistic regression was used to estimate the association between BMI category and surgical site infections (SSIs). RESULTS Recipients with BMI ≥35 kg/m2 had significantly higher rates of SSIs (P < .0001) compared with recipients in all other categories. On multivariable analysis, recipients with BMI ≥35 kg/m2 had increased odds of SSIs compared with normal-weight recipients [odds ratio (OR) 3.34, 95% confidence interval (CI) 1.55-7.22, P = .022). On multivariable and Kaplan-Meier analyses, no BMI groups demonstrated increased odds for death-censored graft failure. CONCLUSION Severe obesity in kidney transplant recipients is associated with increased SSIs, but not kidney allograft failure.
Collapse
Affiliation(s)
- Demetra Tsapepas
- Department of Analytics, Division of Transplantation, NewYork-Presbyterian Hospital, New York, NY, USA.,Department of Surgery, Division of Transplantation, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA
| | - Vanessa Sandra
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA.,Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Leigh Ann Dale
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Yelena Drexler
- Department of Medicine, Division of Nephrology, University of Miami, Miami, FL, USA
| | - Kristen L King
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA.,Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Miko Yu
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA.,Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Katherine Toma
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Jennifer Van Bever
- Department of Analytics, Division of Transplantation, NewYork-Presbyterian Hospital, New York, NY, USA
| | - Navin Sanichar
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA.,Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - S Ali Husain
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA.,Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Sumit Mohan
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA.,Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
|
14
|
Potrykus M, Czaja-Stolc S, Małgorzewicz S, Proczko-Stepaniak M, Dębska-Ślizień A. Diet Management of Patients with Chronic Kidney Disease in Bariatric Surgery. Nutrients 2022; 15:nu15010165. [PMID: 36615822 PMCID: PMC9824280 DOI: 10.3390/nu15010165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
Morbid obesity is considered a civilization disease of the 21st century. Not only does obesity increase mortality, but it is also the most important cause of the shortening life expectancy in the modern world. Obesity is associated with many metabolic abnormalities: dyslipidemia, hyperglycemia, cardiovascular diseases, and others. An increasing number of patients diagnosed with chronic kidney disease (CKD) are obese. Numerous additional disorders associated with impaired kidney function make it difficult to conduct slimming therapy and may also be associated with a greater number of complications than in people with normal kidney function. Currently available treatments for obesity include lifestyle modification, pharmacotherapy, and bariatric surgery (BS). There are no precise recommendations on how to reduce excess body weight in patients with CKD treated conservatively, undergoing chronic dialysis, or after kidney transplantation. The aim of this study was to analyze studies on the bariatric treatment of obesity in this group of people, as well as to compare the recommendations typical for bariatrics and CKD.
Collapse
Affiliation(s)
- Marta Potrykus
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Sylwia Czaja-Stolc
- Department of Clinical Nutrition, Medical University of Gdansk, 80-211 Gdańsk, Poland
- Correspondence: ; Tel.: +48-(58)-349-27-24
| | - Sylwia Małgorzewicz
- Department of Clinical Nutrition, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Monika Proczko-Stepaniak
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, 80-211 Gdańsk, Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, 80-952 Gdańsk, Poland
| |
Collapse
|
|
15
|
Sayilar EI, Ersoy A, Ersoy C, Oruc A, Ayar Y, Sigirli D. The effect of calcineurin inhibitors on anthropometric measurements in kidney transplant recipients. BMC Nephrol 2022; 23:375. [PMID: 36402951 PMCID: PMC9675959 DOI: 10.1186/s12882-022-03004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/10/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This study was designed to investigate the effect of calcineurin inhibitors (CNIs), cyclosporine (CsA), and tacrolimus (Tac) on anthropometrics in kidney transplant recipients. METHODS 111 of 128 adult kidney transplant recipients who received post-transplant CNIs were included in this retrospective study. Anthropometrics were recorded in the pre-transplant and post-transplant 4-year follow-up periods (1st, 3rd, 6th, 12th, 24th, 36th and 48th months). RESULTS Compared to pre-transplant values, significant increases in body weight and body mass index (between 3rd and 48th months), waist and hip circumferences (between 1st and 48th months), waist-to-hip ratio (between 1st and 3rd or 6th months) and neck circumference (between 1st and 12th or 24th months) were observed in both CsA and Tac groups. A significant increase was noted in post-transplant body fat percentage values for the 3rd to 24th months in the CsA group, whereas for the 24th to 48th months in both CsA and Tac groups. Hip circumferences percentage changes from the pre-transplant period to the 1st, 12th and 24th months were significantly higher in CsA than in the Tac group. At each time point, there was no significant difference in percentage changes for other anthropometric parameters between the CsA and Tac groups. De novo diabetes mellitus developed in 8.3% of the CsA group and 19.1% of the Tac group. CONCLUSIONS After a successful kidney transplant, anthropometric measurements increase in most recipients. Although the effect of calcineurin inhibitor type on weight gain is unclear, a regression analysis showed that CNI type was not a risk factor for the development of obesity in the 48th month. However, it is helpful to be cautious about its dyslipidemic effect in patients using CsA and the potential hazards of using Tac in patients with a diabetic predisposition.
Collapse
Affiliation(s)
- Emel Isiktas Sayilar
- Departments of Nephrology, Uludag University Faculty of Medicine, Bursa, Turkey
- Present address: Department of Nephrology, Ufuk University School of Medicine Dr. Ridvan Ege Hospital, Mevlana Blv. No: 86-88, Balgat, Ankara, 06830 Turkey
| | - Alparslan Ersoy
- Departments of Nephrology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Canan Ersoy
- Endocrinology and Metabolism, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Aysegul Oruc
- Departments of Nephrology, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Yavuz Ayar
- Endocrinology and Metabolism, Uludag University Faculty of Medicine, Bursa, Turkey
| | - Deniz Sigirli
- Biostatistics, Uludag University Faculty of Medicine, Bursa, Turkey
| |
Collapse
|
|
16
|
Jarrar F, Tennankore KK, Vinson AJ. Combined Donor-Recipient Obesity and the Risk of Graft Loss After Kidney Transplantation. Transpl Int 2022; 35:10656. [PMID: 36247488 PMCID: PMC9556700 DOI: 10.3389/ti.2022.10656] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022]
Abstract
Background: As the prevalence of obesity increases globally, appreciating the effect of donor and recipient (DR) obesity on graft outcomes is of increasing importance. Methods: In a cohort of adult, kidney transplant recipients (2000-2017) identified using the SRTR, we used Cox proportional hazards models to examine the association between DR obesity pairing (body mass index (BMI) >30 kg/m2), and death-censored graft loss (DCGL) or all-cause graft loss, and logistic regression to examine risk of delayed graft function (DGF) and ≤30 days graft loss. We also explored the association of DR weight mismatch (>30 kg, 10-30 kg (D>R; D
Collapse
Affiliation(s)
- Faisal Jarrar
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Karthik K. Tennankore
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Amanda J. Vinson
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Division of Nephrology, Department of Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| |
Collapse
|
|
17
|
Buemi A, Romero L, Zech F, Darius T, De Meyer M, Devresse A, Kanaan N, Goffin E, Mourad M. Impact of Recipient Obesity on Kidney Transplantation Outcome: A Retrospective Cohort Study with a Matched Comparison. Transplant Proc 2022; 54:1786-1794. [PMID: 35940948 DOI: 10.1016/j.transproceed.2022.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/15/2022] [Accepted: 03/26/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effect of a recipient's obesity on posttransplant complications and patient and graft survival. METHODS A single-institution, retrospective study was performed on obese renal transplant recipients (BMI ≥ 30 kg/m2, n = 102) from January 2010 to December 2018, matched with non-obese recipients (BMI < 30 kg/m2, n = 204). For comparison, for every obese patient we selected 2 nonobese patients with a similar age, sex, and period of transplantation. The comparative analysis included patient and graft survival as primary outcomes and graft function and postoperative complications as a secondary outcome. RESULTS Recipient demographics were comparable in both groups except for diabetic nephropathy in obese patients (P = .0006). Obesity was strongly related to a poorer patient survival (risk ratio [RR] = 2.83 confidence interval [CI] 95% 1.14-7.04; P = .020) but there was no observed difference in graft survival (P = .6). While early graft function was inferior in the obese population (RR = 2.41; CI 95% 1.53-3.79; P = .00016), during late follow-up, no statistically significant differences were observed between both groups (P = .36). Obese recipients had a significantly higher risk of delayed graft function (RR = 1.93; CI 95% (1.19-3.1), P = .0077), heart infarction (RR = 7; CI 95% 1.68-29.26; P = .0042), wound infections (RR = 8; CI 95% 1.96-32.87; P = .0015), diabetes aggravation (RR = 3.13; CI 95% 1.29-7.6; P = .011), and surgical revision for eventration (RR = 8; CI 95% 1.22-52.82; P = .026) when compared with nonobese recipients. CONCLUSIONS Despite the inferior early kidney graft function in obese recipients, there was no difference observed at the long-term follow-up. However, recipient obesity demonstrated a negative effect on patient survival and postoperative complications.
Collapse
Affiliation(s)
- Antoine Buemi
- Department of Surgery, Surgery and Abdominal Transplantation Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| | - Laura Romero
- Department of Surgery, Surgery and Abdominal Transplantation Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Francis Zech
- Experimental and Clinical Research Institute, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Tom Darius
- Department of Surgery, Surgery and Abdominal Transplantation Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Martine De Meyer
- Department of Surgery, Surgery and Abdominal Transplantation Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Arnaud Devresse
- Department of Internal Medicine, Nephrology Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Nada Kanaan
- Department of Internal Medicine, Nephrology Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Eric Goffin
- Department of Internal Medicine, Nephrology Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Michel Mourad
- Department of Surgery, Surgery and Abdominal Transplantation Division, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| |
Collapse
|
|
18
|
Altheaby A, Alajlan N, Shaheen MF, Abosamah G, Ghallab B, Aldawsari B, Rashidi A, Gafar M, Arabi Z. Weight gain after renal transplant: Incidence, risk factors, and outcomes. PLoS One 2022; 17:e0268044. [PMID: 35653356 PMCID: PMC9162351 DOI: 10.1371/journal.pone.0268044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 04/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Renal transplantation is the definitive treatment for patients with end-stage renal disease (ESRD). It is associated with better quality of life and patient survival. Nevertheless, these benefits come with rising concerns about weight gain and metabolic abnormalities, which adversely impact transplant outcomes. Objective The objective of this study is to estimate the incidence of weight gain in the first year post-renal transplant in addition to the assessment of potential risk factors and the resulting outcome of the graft. Methods We conducted a single-center retrospective cohort study of all 295 patients who underwent kidney transplantation at King Abdulaziz Medical City (KAMC) between January 2016 and December 2019. Clinical and laboratory variables were collected from electronic records. Continuous variables were reported as mean ± standard deviation. Comparison between groups was assessed by unpaired t-test or Mann-Whitney U test while follow-up data were compared using paired t-test and repeated measures ANOVA. Association between the potential risk factors and the weight gain was assessed by means of binary logistic regression analysis. Results Significant weight gain was observed in 161 (54.6%) patients. Females were 119 (40.30%) of the cohort. The mean age was 45.3±15.1 years. The prevalence of diabetes was 234 (79.6%), while hypertensives constituted 77 (26.3%). The comparison between patients who gained weight significantly and patients with stable weight showed a numerical higher prevalence of female gender in patients who had more weight gain (44.1% vs. 35.8%), higher diabetes, higher rate of a living donor, and statistically significant lower dialysis duration before transplant. Other clinical and laboratory variables were comparable between the two groups. Conclusion Our study showed a high incidence of clinically significant weight gain among patients post-renal transplantation. Patients with lower dialysis duration, a living kidney donor and those who are obese at baseline were at higher risk of gaining weight. Patients who underwent kidney transplantation should be monitored closely for weight gain and further studies are needed to determine the risk factors and appropriate interventions.
Collapse
Affiliation(s)
- Abdulrahman Altheaby
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- * E-mail:
| | - Nuha Alajlan
- Department of Medicine, King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Mohammed F. Shaheen
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ghaleb Abosamah
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Basma Ghallab
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Basayl Aldawsari
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Awatif Rashidi
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohammed Gafar
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ziad Arabi
- Organ Transplant Center and Hepatobiliary Sciences Department, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| |
Collapse
|
|
19
|
Chertow GM, Vart P, Jongs N, Langkilde AM, McMurray JJV, Correa-Rotter R, Rossing P, Sjöström CD, Stefansson BV, Toto RD, Wheeler DC, Heerspink HJL. Quételet (body mass) index and effects of dapagliflozin in chronic kidney disease. Diabetes Obes Metab 2022; 24:827-837. [PMID: 34984791 DOI: 10.1111/dom.14641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/28/2021] [Accepted: 01/01/2022] [Indexed: 01/08/2023]
Abstract
AIM To assess the effects of dapagliflozin in patients with chronic kidney disease (CKD) and albuminuria, with and without type 2 diabetes, stratified by the Quételet (body mass) index (BMI). METHODS We randomized 4304 adult patients with an estimated glomerular filtration rate (eGFR) of 25-75 ml/min/1.73m2 and urinary albumin-to-creatinine ratio of 200-5000 mg/g to dapagliflozin 10 mg/day or placebo. The primary outcome was a composite of sustained decline in eGFR of 50% or more, kidney failure, or death from kidney or cardiovascular causes. Secondary outcomes included kidney composite endpoint (primary composite endpoint without cardiovascular death), cardiovascular composite endpoint (hospitalized heart failure/ cardiovascular death), and all-cause mortality. We categorized participants according to World Health Organization BMI criteria: lean/ideal (<25 kg/m2 ), overweight (25-< 30 kg/m2 ), grade 1 obesity (30-<35 kg/m2 ), and grade 2/3 obesity (≥35 kg/m2 ). RESULTS Of 4296 (99.8%) randomized participants, 888 (20.7%), 1491 (34.7%), 1136 (26.4%), and 781 (18.2%) were categorized as lean/ideal, overweight, grade 1 obesity, and grade 2/3 obesity, respectively. Median follow-up was 2.4 years. Benefits of dapagliflozin were observed independent of baseline BMI for primary and secondary endpoints. Hazard ratios (95% CI) for dapagliflozin versus placebo for the primary composite endpoint were 0.60 (0.43, 0.85), 0.55 (0.40, 0.75), 0.71 (0.49, 1.04), and 0.57 (0.37, 0.87) among participants in the lean/ideal, overweight, grade 1 obesity, and grade 2/3 obesity groups (interaction P = .72). CONCLUSION Among participants with CKD and albuminuria, with or without type 2 diabetes, kidney and cardiovascular benefits of dapagliflozin were evident and consistent across the BMI spectrum.
Collapse
Affiliation(s)
- Glenn M Chertow
- Departments of Medicine and Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Priya Vart
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Niels Jongs
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anna Maria Langkilde
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - John J V McMurray
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Ricardo Correa-Rotter
- The National Medical Science and Nutrition Institute Salvador Zubiran, Mexico City, Mexico
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - C David Sjöström
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Bergur V Stefansson
- Late-Stage Development, Cardiovascular, Renal, and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Robert D Toto
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - David C Wheeler
- Department of Renal Medicine, University College London, London, UK
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- The George Institute for Global Health, Sydney, Australia
| |
Collapse
|
|
20
|
Tan A, Wilson S, Sumithran P. The application of body mass index-based eligibility criteria may represent an unjustified barrier to renal transplantation in people with obesity. Clin Obes 2022; 12:e12505. [PMID: 34964256 DOI: 10.1111/cob.12505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 12/22/2022]
Abstract
The prevalence of both obesity and end-stage kidney disease is increasing. In many centres, obesity is considered a relative contraindication to kidney transplantation due to an association with short- and longer-term adverse outcomes. This leads to delayed transplant waitlisting and longer organ waiting times for people with obesity. This review evaluates whether intentional pre-transplant weight loss in people with obesity improves kidney transplant outcomes. There are currently no data showing that non-surgical weight loss of 10% or more improves graft or patient survival over 4-5 years. Outcomes from bariatric surgery cohorts have been generally neutral or favourable after pre-transplant weight loss of ~25%. Given the survival benefit of kidney transplantation compared to maintenance dialysis, and the difficulty of achieving and maintaining weight loss, the common practice of recommending weight loss to achieve arbitrary targets prior to waiting list activation needs to be carefully considered.
Collapse
Affiliation(s)
- Alanna Tan
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
| | - Scott Wilson
- Department of Nephrology, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Priya Sumithran
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia
- Department of Medicine (St Vincent's), University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
|
21
|
Yaseri M, Alipoor E, Seifollahi A, Rouhifard M, Salehi S, Hosseinzadeh-Attar MJ. Association of obesity with mortality and clinical outcomes in children and adolescents with transplantation: A systematic review and meta-analysis. Rev Endocr Metab Disord 2021; 22:847-858. [PMID: 33730228 DOI: 10.1007/s11154-021-09641-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
Obesity might be associated with mortality and clinical outcomes following transplantation; however, the direction of this relationship has not been well-recognized in youth. The aim of this systematic review and meta-analysis was to investigate the association of obesity with post-transplant mortality and clinical outcomes in children and adolescents. Following a systematic search of observational studies published by December 2018 in PubMed, Scopus, Embase, and Cochrane library, 15 articles with total sample size of 50,498 patients were included in the meta-analysis. The main outcome was mortality and secondary outcomes included acute graft versus host disease (GVHD), acute rejection, and overall graft loss. The pooled data analyses showed significantly higher odds of long term mortality (OR 1.30, 95% CI 1.15-1.48, P < 0.001, I2 = 50.3%), short term mortality (OR 1.79, 95% CI 1.19-2.70, P = 0.005, I2 = 59.6%), and acute GVHD (OR 2.13, 95% CI 1.5-3.02, P < 0.001, I2 = 1.7%) in children with obesity. There were no significant differences between patients with and without obesity in terms of acute rejection (OR 1.07, 95% CI 0.98-1.16, P = 0.132, I2 = 7.5%) or overall graft loss (OR 1.04, 95% CI 0.84-1.28, P = 0.740, I2 = 51.6%). This systematic review and meta-analysis has stated higher post-transplant risk of short and long term mortality and higher risk of acute GVHD in children with obesity compared to those without obesity. Future clinical trials are required to investigate the effect of pre-transplant weight management on post-transplant outcomes to provide insights into the clinical application of these findings. This may in turn lead to establish guidelines for the management of childhood obesity in transplantations.
Collapse
Affiliation(s)
- Mehdi Yaseri
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Alipoor
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Atefeh Seifollahi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahtab Rouhifard
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Shiva Salehi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Javad Hosseinzadeh-Attar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
|
22
|
Spiers HVM, Sharma V, Woywodt A, Sivaprakasam R, Augustine T. Robot-assisted kidney transplantation: an update. Clin Kidney J 2021; 15:635-643. [PMID: 35371439 PMCID: PMC8967665 DOI: 10.1093/ckj/sfab214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
Renal transplantation has become the gold-standard treatment for the majority of patients with established renal failure. Recent decades have seen significant progress in immunosuppressive therapies and advances in post-transplant management of recipients, resulting in improved graft and patient outcomes. However, the open technique of allograft implantation has stood the test of time, remaining largely unchanged. In a world where major advances in surgery have been facilitated by innovations in the fields of biotechnology and medical instrumentation, minimally invasive options have been introduced for the recipient undergoing kidney transplantation. In this review we present the evolution of minimally invasive kidney transplantation, with a specific focus on robot-assisted kidney transplant and the benefits it offers to specific patient groups. We also discuss the ethical concerns that must be addressed by transplant teams considering developing or referring to robotic programs.
Collapse
Affiliation(s)
- Harry V M Spiers
- Department of Transplantation, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Videha Sharma
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Rajesh Sivaprakasam
- Department of Transplant and Robotic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| |
Collapse
|
|
23
|
Ku E, McCulloch CE, Roll GR, Posselt A, Grimes BA, Johansen KL. Bariatric surgery prior to transplantation and risk of early hospital re-admission, graft failure, or death following kidney transplantation. Am J Transplant 2021; 21:3750-3757. [PMID: 34331744 PMCID: PMC10184683 DOI: 10.1111/ajt.16779] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/05/2021] [Accepted: 07/22/2021] [Indexed: 01/25/2023]
Abstract
Bariatric surgery has been shown to be safe in the dialysis population. Whether bariatric surgery before kidney transplantation influences posttransplant outcomes has not been examined nationally. We included severely obese (BMI >35) dialysis patients between 18 and 70 years who received a kidney transplant according to the US Renal Data System. We determined the association between history of bariatric surgery and risk of 30-day readmission, graft failure, or death after transplantation using multivariable logistic, Fine-Gray, and Cox models. We included 12 573 patients, of whom 503 (4%) received bariatric surgery before transplantation. Median age at transplant was 53 years; 42% were women. Overall, history of bariatric surgery was not statistically significantly associated with graft failure (HR 1.02; 95% CI 0.77-1.35) or death (HR 1.10; 95% CI 0.84-1.45). However, sleeve gastrectomy (vs. no bariatric surgery) was associated with lower risk of graft failure (HR 0.39; 95% CI 0.16-0.95). In conclusion, history of bariatric surgery prior to kidney transplantation was not associated with allograft or patient survival, but findings varied by surgery type. Sleeve gastrectomy was associated with better graft survival and should be considered in severely obese transplant candidates receiving dialysis.
Collapse
Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, California.,Division of Pediatric Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Garrett R Roll
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Andrew Posselt
- Division of Transplant Surgery, Department of Surgery, University of California San Francisco, San Francisco, California
| | - Barbara A Grimes
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Kirsten L Johansen
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| |
Collapse
|
|
24
|
Lee SD, Rawashdeh B, McCracken EKE, Cantrell LA, Kharwat B, Demirag A, Agarwal A, Brayman KL, Pelletier SJ, Goldaracena N, Fox E, Oberholzer J. Robot-assisted kidney transplantation is a safe alternative approach for morbidly obese patients with end-stage renal disease. Int J Med Robot 2021; 17:e2293. [PMID: 34080270 DOI: 10.1002/rcs.2293] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023]
Abstract
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 frequency-matched 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.
Collapse
Affiliation(s)
- Seung Duk Lee
- Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Badi Rawashdeh
- Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Emily K E McCracken
- Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Leigh A Cantrell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia, USA
| | - Bassel Kharwat
- Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Alp Demirag
- Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Avinash Agarwal
- Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Kenneth L Brayman
- Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Shawn J Pelletier
- Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Nicolas Goldaracena
- Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Emily Fox
- Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - José Oberholzer
- Division of Transplant Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
| |
Collapse
|
|
25
|
Smyrli M, Tsouka G, Apostolou T, Vougas V. Body Mass Index and Kidney Donor Profile Index as Prognostic Markers of the Outcome of Renal Transplantation. Transplant Proc 2021; 53:2756-2759. [PMID: 34565581 DOI: 10.1016/j.transproceed.2021.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/27/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to determine the effects of Kidney Donor Profile Index (KDPI) and body mass index (BMI) of the deceased donor on the kidney allograft outcome 1 year after transplantation. METHODS We retrospectively studied 98 deceased kidney allograft donors with a mean age of 56 ± 12 years. The donors were divided into 5 groups according to their BMI: Normal ΒΜΙ = 25 (n = 25); ΒΜΙ 25 to 29 = Overweight (n = 33); ΒΜΙ 30 to 34.9 = Obese class I (n = 19); ΒΜΙ 35 to 39 = Obese class ΙΙ (n = 11); and ΒΜΙ >40 = Obese class III (n = 10). We examined the impact of the deceased donor's BMI and KDPI on delayed graft function (DGF) and estimated renal glomerular filtration rate (eGFR) (measured by the Chronic Kidney Disease Epidemiology Collaboration equation) 1 year after transplantation. RESULTS Donor BMI significantly increased the prevalence of DGF (P = .031), and it was associated with higher cold ischemia time (P = .021). However, there was no significant association between the aforementioned BMI groups and 1-year eGFR (P = 0.57), as deceased grafts from donors with increased BMI (BMI > 40) gained sufficient renal function during the first year of transplantation. Moreover, high KDPI was associated not only with DGF (P = .015), but also with decreased values of eGFR (P = .033). CONCLUSION In this population, we identified no significant association between donor BMI and long-term clinical outcomes in deceased donor kidney transplants. KDPI, and not ΒΜΙ, of the deceased donor seems to be a good prognostic factor of renal function at the end of the first year after kidney transplant, whereas high BMI and high KDPI markedly induce DGF.
Collapse
Affiliation(s)
- Maria Smyrli
- Nephrology Department, Antonios. B. Billis, General Hospital of Evangelismos, Athens, Greece.
| | - Glykeria Tsouka
- Nephrology Department, Antonios. B. Billis, General Hospital of Evangelismos, Athens, Greece
| | - Theofanis Apostolou
- Nephrology Department, Antonios. B. Billis, General Hospital of Evangelismos, Athens, Greece
| | - Vasileios Vougas
- Surgical Unit - Transplantation Unit, General Hospital of Evangelismos, Athens, Greece
| |
Collapse
|
|
26
|
Martin-Moreno PL, Shin HS, Chandraker A. Obesity and Post-Transplant Diabetes Mellitus in Kidney Transplantation. J Clin Med 2021; 10:2497. [PMID: 34198724 PMCID: PMC8201168 DOI: 10.3390/jcm10112497] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022] Open
Abstract
Worldwide, the prevalence obesity, diabetes, and chronic kidney disease is increasing apace. The relationship between obesity and chronic kidney disease is multidimensional, especially when diabetes is also considered. The optimal treatment of patients with chronic kidney disease includes the need to consider weight loss as part of the treatment. The exact relationship between obesity and kidney function before and after transplantation is not as clear as previously imagined. Historically, patients with obesity had worse outcomes following kidney transplantation and weight loss before surgery was encouraged. However, recent studies have found less of a correlation between obesity and transplant outcomes. Transplantation itself is also a risk factor for developing diabetes, a condition known as post-transplant diabetes mellitus, and is related to the use of immunosuppressive medications and weight gain following transplantation. Newer classes of anti-diabetic medications, namely SGLT-2 inhibitors and GLP-1 agonists, are increasingly being recognized, not only for their ability to control diabetes, but also for their cardio and renoprotective effects. This article reviews the current state of knowledge on the management of obesity and post-transplant diabetes mellitus for kidney transplant patients.
Collapse
Affiliation(s)
- Paloma Leticia Martin-Moreno
- Department of Nephrology, Clinica Universidad de Navarra, Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Ho-Sik Shin
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University, Busan 49267, Korea;
- Transplantation Research Institute, Kosin University College of Medicine, Busan 49367, Korea
| | - Anil Chandraker
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| |
Collapse
|
|
27
|
AlEnazi NA, Ahmad KS, Elsamahy IA, Essa MS. Feasibility and impact of laparoscopic sleeve gastrectomy after renal transplantation on comorbidities, graft function and quality of life. BMC Surg 2021; 21:235. [PMID: 33947375 PMCID: PMC8097958 DOI: 10.1186/s12893-021-01138-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/09/2021] [Indexed: 01/07/2023] Open
Abstract
Background The aim of this study is to clarify the feasibility and effect of laparoscopic sleeve gastrectomy (LSG) on comorbidities, graft function and quality of life in patients who underwent renal transplantation (RT). Methods This is a retrospective review of five patients who underwent LSG after RT. Demographic data, anthropometric parameters, the effect on comorbidities, postoperative course, immunosuppressive medications, causes of RT, renal function, the survival of graft, and quality of life after SG in obese patients with a history of RT were assessed using BAROS–Moorhead–Ardelt survey Results From September 2015 to September 2019, 5 renal transplant patients underwent LSG; three female, and two male. Median body mass index (BMI) decreased from 42.17 kg/m2 (range 36–55) before surgery to 28.16 kg/m2 (range 25–42) after surgery. Improvement in blood pressure, triglyceride, and cholesterol levels was observed, and all cases were able to decrease their medications. Insulin was stopped and replaced with linagliptin in all diabetic patients. Graft function improved, and proteinuria level decreased in all cases. All patients reported to have an excellent quality of life. Conclusion LSG showed excellent outcomes in this high-risk group of patients regarding comorbidities, graft function and quality of life
Collapse
Affiliation(s)
- Naif A AlEnazi
- Department of General Surgery, Ad Diriyah Hospital, Ar Rihab, Riyadh, Saudi Arabia.
| | - Khaled S Ahmad
- Department of General Surgery, Ad Diriyah Hospital, Ar Rihab, Riyadh, Saudi Arabia
| | - Ilham A Elsamahy
- Department of Anesthesia, Islamic Center for Heart Diseases and Cardiac Surgeries, Faculty of Medicine, El-Azhar University, Cairo, Egypt
| | - Mohamed S Essa
- Department of General Surgery, Faculty of Medicine, Benha University Hospital, Benha University, Benha, Egypt
| |
Collapse
|
|
28
|
Weight Loss After Bariatric Surgery in Morbidly Obese End-Stage Kidney Disease Patients as Preparation for Kidney Transplantation. Matched Pair Analysis in a High-Volume Bariatric and Transplant Center. Obes Surg 2021; 30:2708-2714. [PMID: 32249367 PMCID: PMC7260258 DOI: 10.1007/s11695-020-04555-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The number of morbidly obese kidney transplant candidates is growing. They have limited access to kidney transplantation and are at a higher risk of postoperative complications. Bariatric surgery is considered as a safe weight loss method in those patients. Objectives Matched pair analysis was designed to analyze the preparatory and postoperative weight loss after bariatric procedures in end-stage kidney disease (ESKD) and non-ESKD morbidly obese patients. Methods Twenty patients with ESKD underwent bariatric surgery in our Centre of Excellence for Bariatric and Metabolic Surgery between 2015 and 2019 (nine one-anastomosis gastric bypasses, nine Roux-en-Y gastric bypasses, and two sleeve gastrectomies). They were compared with matched pairs from a dataset of 1199 morbidly obese patients without ESKD. Data on demographic factors and comorbidities was recorded. BMI was obtained at the start of the preparatory period preceding the bariatric procedure, at the time of procedure, and during the 1-year follow-up. Results The ESKD and non-ESKD patients did not differ significantly in preoperative weight loss (13.00 ± 11.69 kg and 15.22 ± 15.96 kg respectively, p = 0.619). During the 1-year follow-up, the weight loss was similar to the non-ESKD group. In the first 3 months, faster weight loss in ESKD was observed. Initial and follow-up BMI values did not differ significantly between groups. We demonstrated that obese patients with ESKD can lose weight as effectively as non-ESKD patients. Conclusion Morbidly obese ESKD patients have an equal weight loss to patients without ESKD. Bariatric surgery could improve access to kidney transplantation and may potentially improve transplantation outcomes of obese patients with ESKD.
Collapse
|
|
29
|
Boslooper-Meulenbelt K, Boonstra MD, van Vliet IMY, Gomes-Neto AW, Osté MCJ, Poelman MP, Bakker SJL, de Winter AF, Navis GJ. Food Literacy Is Associated With Adherence to a Mediterranean-Style Diet in Kidney Transplant Recipients. J Ren Nutr 2021; 31:628-636. [PMID: 33678545 DOI: 10.1053/j.jrn.2020.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/05/2020] [Accepted: 12/27/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Adherence to a Mediterranean-style diet is associated with improved health outcomes in kidney transplant recipients (KTR). However, poor dietary habits, including excessive sodium intake, are common in KTR, indicating difficulties with incorporating a healthy diet into daily life. Food literacy is identified as potential facilitator of a healthy diet, but the precise relationship between food literacy and dietary intake in KTR has not been investigated. This study examined food literacy levels in KTR and its association with adherence to a Mediterranean-style diet and sodium intake. METHODS This cross-sectional study is part of the TransplantLines Cohort and Biobank Study. Food literacy was measured with the Self-Perceived Food Literacy (SPFL) questionnaire. Dietary intake assessment with food frequency questionnaires was used to calculate the Mediterranean Diet Score. Sodium intake was based on the 24-hour urinary sodium excretion rate. Associations of SPFL with Mediterranean Diet Score and sodium intake were assessed with univariable and multivariable linear regression analyses. RESULTS In total, 148 KTR (age 56 [48-66]; 56% male) completed the SPFL questionnaire with a mean SPFL score of 3.63 ± 0.44. Higher SPFL was associated with a higher Mediterranean Diet Score in KTR (β = 1.51, 95% confidence interval 0.88-2.12, P ≤ .001). Although KTR with higher food literacy tended to have a lower sodium intake than those with lower food literacy (P = .08), the association of food literacy with sodium intake was not significant in a multivariable regression analysis (β = 0.52 per 10 mmol/24-hour increment, 95% confidence interval -1.79 to 2.83, P = .66). CONCLUSIONS Higher levels of food literacy are associated with better adherence to a Mediterranean-style diet in KTR. No association between food literacy and sodium intake was found. Further studies are needed to determine if interventions on improving food literacy contribute to a healthier diet and better long-term outcomes in KTR.
Collapse
Affiliation(s)
- Karin Boslooper-Meulenbelt
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Marco D Boonstra
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Iris M Y van Vliet
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Antonio W Gomes-Neto
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maryse C J Osté
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Maartje P Poelman
- Chairgroup Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, The Netherlands
| | - Stephan J L Bakker
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andrea F de Winter
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerjan J Navis
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
|
30
|
Campara M, Lourenco LM, Melaragno JI, Kaiser TE. Implications for body weight extremes in solid organ transplantation. Pharmacotherapy 2021; 41:44-58. [PMID: 33301647 DOI: 10.1002/phar.2493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/19/2020] [Accepted: 12/01/2020] [Indexed: 12/17/2022]
Abstract
The pharmacokinetic profiles of medications are altered in overweight and underweight patients, but few studies have described these differences in patients with body mass index extremes. As solid organ transplant programs expand their candidate selection criteria to accommodate a growing population of patients with weight extremes, it has become imperative to understand and evaluate the impact weight extremes have on the pharmacokinetics of life-sustaining immunosuppression in this population. This review will describe pharmacokinetic and dosing considerations for weight extremes in solid organ transplant recipients, including changes following bariatric surgeries, non-pharmacologic and pharmacologic management strategies for weight loss and gain, and potential drug-drug interactions with popular weight management products.
Collapse
Affiliation(s)
- Maya Campara
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | | | | | | |
Collapse
|
|
31
|
Gorgov E, Rayman S, Carmeli I, Keidar A. Laparoscopic Single Anastomosis Gastric Bypass for Morbid Obesity Following Renal Transplantation: a Case. Obes Surg 2021; 31:1848-1851. [PMID: 33420978 DOI: 10.1007/s11695-020-05108-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Eliyahu Gorgov
- Department of General Surgery, Assuta Medical Centers, Ashdod Campus, 7 Ha'Refua St., 7747629, Ashdod, Israel. .,Department of General Surgery, Assuta Ashdod Public Hospital, Ashdod, Israel. .,Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel.
| | - Shlomi Rayman
- Department of General Surgery, Assuta Ashdod Public Hospital, Ashdod, Israel.,Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel
| | - Idan Carmeli
- Department of General Surgery, Assuta Ashdod Public Hospital, Ashdod, Israel.,Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel
| | - Andrei Keidar
- Department of General Surgery, Assuta Ashdod Public Hospital, Ashdod, Israel.,Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel
| |
Collapse
|
|
32
|
Boslooper-Meulenbelt K, van Vliet IMY, Gomes-Neto AW, de Jong MFC, Bakker SJL, Jager-Wittenaar H, Navis GJ. Malnutrition according to GLIM criteria in stable renal transplant recipients: Reduced muscle mass as predominant phenotypic criterion. Clin Nutr 2020; 40:3522-3530. [PMID: 33341314 DOI: 10.1016/j.clnu.2020.11.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/24/2020] [Accepted: 11/30/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Malnutrition has a negative impact on quality of life and survival in renal transplant recipients (RTR). Therefore, malnutrition detection is important in RTR, but this may be hampered by concomitant presence of weight gain and overweight. Recently, the Global Leadership Initiative on Malnutrition (GLIM) developed a set of diagnostic criteria for malnutrition. We aimed to assess the prevalence of malnutrition according to the GLIM criteria and the distribution of phenotypic criteria in RTR. Additionally, we examined the potential value of 24-h urinary creatinine excretion rate (CER) as alternative measure for the criterion reduced muscle mass. METHODS We used data from stable outpatient RTR included in the TransplantLines Cohort and Biobank Study (NCT02811835). Presence of weight loss and reduced intake or assimilation were derived from Patient-Generated Subjective Global Assessment (PG-SGA) item scores. Reduced muscle mass was assessed by multi-frequency bio-electrical impedance analysis (MF-BIA) and defined as an appendicular skeletal muscle mass index (ASMI) < 7 kg/m2 for men and <5.5 kg/m2 for women, and in additional analysis defined as creatinine-height index (CHI, based on 24 h urine CER) < 80%. Inflammation was present if C-reactive protein (CRP) was >5 mg/L. Malnutrition was defined as presence of at least one phenotypic (weight loss and/or low BMI and/or reduced muscle mass) and one etiologic criterion (reduced intake/assimilation and/or disease burden/inflammation). RESULTS We included 599 RTR (55 ± 13 years old, 62% male, BMI 27.2 ± 4.7 kg/m2) at a median of 3.1 years after transplantation. According to GLIM criteria, 14% was malnourished, of which 91% met the phenotypic criterion for reduced muscle mass. Similar results were found by using CHI as measure for muscle mass (13% malnutrition of which 79% with reduced muscle mass). CONCLUSIONS Malnutrition is present in one in 7 stable RTR, with reduced muscle mass as the predominant phenotypic criterion. Assessment of nutritional status, most importantly muscle status, is warranted in routine care, to prevent malnutrition in RTR from remaining undetected and untreated. The diagnostic value of 24-h urinary CER in this regard requires further investigation.
Collapse
Affiliation(s)
- K Boslooper-Meulenbelt
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Iris M Y van Vliet
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - António W Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Margriet F C de Jong
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, the Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
|
33
|
Effects of Obesity on Postoperative Complications and Graft Survival After Kidney Transplantation. Transplant Proc 2020; 52:3153-3159. [DOI: 10.1016/j.transproceed.2020.02.178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
|
|
34
|
IMC, tour de taille et transplantation rénale : contraintes, réalités et enjeux pour un centre spécialisé de l’obésité. Revue de la littérature. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
|
35
|
Castle EM, Greenwood J, Chilcot J, Greenwood SA. Usability and experience testing to refine an online intervention to prevent weight gain in new kidney transplant recipients. Br J Health Psychol 2020; 26:232-255. [PMID: 32931645 DOI: 10.1111/bjhp.12471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 07/15/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Weight gain in the first year following kidney transplantation increases the risk of adverse health outcomes. Currently, there is no recognized intervention available to prevent weight gain after kidney transplantation. An online kidney transplant-specific resource, entitled Exercise in Renal Transplant Online (ExeRTiOn), has been co-created by a multi-professional team, including patients, to assist with weight prevention. This study aimed to evaluate patient and health care professional usability and experience of the ExeRTiOn online resource. DESIGN Qualitative study utilizing 'Think-Aloud' and semi-structured interviews. METHODS Participants (n = 17) were purposively sampled to include new kidney transplant recipients (n = 11) and transplant health care professionals (n = 6). Kidney transplant recipient participants were from a spread of physical activity levels based on scores from the General Practice Physical Activity Questionnaire (GPPAQ). 'Think-Aloud' interviews assessed the usability of ExeRTiOn. Semi-structured interviews explored participants' experience of ExeRTiOn, weight gain, and physical activity. The data set were analysed thematically. Participant characteristics, including login data and self-reported body weight, were collected. RESULTS Data analyses identified valued intervention content and usability aspects which were summarized by two themes. The first theme 'You need to know how to manage yourself' included subthemes: (1) the resource filled a guidance gap, (2) expert patient content resonated, and (3) the importance of goal setting and monitoring progress. The second theme 'room for improvement' included subthemes: (2) web support and (2) content and operational change suggestions. CONCLUSIONS Results have allowed for identification of potential areas for resource refinement. This has facilitated iterative enhancement of ExeRTiOn in preparation for a randomized controlled feasibility trial.
Collapse
Affiliation(s)
- Ellen M Castle
- Therapies Department, King's College Hospital, NHS Trust, UK.,King's Kidney Care, King's College Hospital, UK.,Renal Sciences, King's College London, UK
| | - James Greenwood
- Victor Horsley Department of Neurosurgery, University College London Hospital, UK
| | - Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sharlene A Greenwood
- Therapies Department, King's College Hospital, NHS Trust, UK.,King's Kidney Care, King's College Hospital, UK.,Renal Sciences, King's College London, UK
| |
Collapse
|
|
36
|
Pinar U, Rod X, Mageau A, Renard Y, Lebacle C, Barrou B, Drouin S, Irani J, Bessede T. Surgical complications risk in obese and overweight recipients for kidney transplantation: a predictive morphometric model based on sarcopenia and vessel-to-skin distance. World J Urol 2020; 39:2223-2230. [PMID: 32785765 DOI: 10.1007/s00345-020-03407-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Sarcopenia or adipose tissue distribution within obese and overweight renal transplanted have been poorly evaluated. Our objective was to evaluate morphometric markers to predict surgical complications in kidney transplantation. METHODS We retrospectively included patients with a BMI > 25 kg/m2 undergoing kidney transplantation from 2012 to 2017. Following measurements were performed on CT-scan sections: Sub-cutaneous Adipose Tissue surface (SAT), Visceral Adipose Tissue surface (VAT), Vessel-to-Skin distance (VSK), Abdominal Perimeter (AP), and Psoas surface. A multivariable logistic regression model with BMI was compared to a model containing morphometric variables to determine the best predictive model for surgical complications. RESULTS 248 patients were included, 15 (6%) experienced transplant nephrectomy, 18 (7.3%) urinary leakage, and 29 (11.7%) subcapsular renal hematoma. Multivariable logistic regression evidenced that sarcopenia and VSK were risk factors of surgical complication within a year post-transplantation (respectively, OR = 0.9, 95%CI (0.8-0.9), p = 0.04 and OR = 1.2, 95%CI (1.1-1.3), p = 0.002). Area under the curve for a predictive model including VSK, age and psoas surface was 0.69, whereas BMI model was 0.65. CONCLUSION Combined morphometric parameters of obesity were associated with surgical complications in kidney transplantation. Morphometric threshold may provide a more accurate and objective criteria than BMI to evaluate kidney transplantation outcomes. External validation is needed.
Collapse
Affiliation(s)
- Ugo Pinar
- Department of Urology, Hôpital de Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin-Bicêtre, 94270, France.
- Department of Urology and Transplantation Surgery, Hôpital Bicêtre, AP-HP. Université Paris Saclay, 78 rue du général Leclerc, Le Kremlin-Bicêtre, 94270, France.
| | - Xavier Rod
- Department of Urology and Renal Transplantation, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, AP-HP. Sorbonne Université, Paris, 75013, France
| | - Arthur Mageau
- Department of Internal Medicine, Hôpital Henri Mondor, AP-HP, Université Paris Saclay, Créteil, 94010, France
| | - Yohann Renard
- Department of Visceral Surgery, Reims, Champagne-Ardenne University, Robert Debré University Hospital, Reims, France
| | - Cedric Lebacle
- Department of Urology, Hôpital de Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin-Bicêtre, 94270, France
| | - Benoit Barrou
- Department of Urology and Renal Transplantation, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, AP-HP. Sorbonne Université, Paris, 75013, France
| | - Sarah Drouin
- Department of Urology and Renal Transplantation, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, AP-HP. Sorbonne Université, Paris, 75013, France
| | - Jacques Irani
- Department of Urology, Hôpital de Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin-Bicêtre, 94270, France
| | - Thomas Bessede
- Department of Urology, Hôpital de Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin-Bicêtre, 94270, France
- U1195, Université Paris-Saclay, Inserm, Le Kremlin-Bicêtre, 94276, France
| |
Collapse
|
|
37
|
Dietary Diversity Score: Implications for Obesity Prevention and Nutrient Adequacy in Renal Transplant Recipients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145083. [PMID: 32674484 PMCID: PMC7399872 DOI: 10.3390/ijerph17145083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/28/2020] [Accepted: 07/08/2020] [Indexed: 02/05/2023]
Abstract
Obesity affects both medical and surgical outcomes in renal transplant recipients (RTRs). Dietary diversity, an important component of a healthy diet, might be a useful nutritional strategy for monitoring patients with obesity. In this cross-sectional study, the data of 85 eligible RTRs were analyzed. Demographic data, routine laboratory data, and 3-day dietary data were collected. Participants were grouped into nonobesity and obesity groups based on body mass index (BMI) (for Asian adults, the cutoff point is 27 kg/m2). Dietary diversity score (DDS) was computed by estimating scores for the six food groups emphasized in the Food Guide. The mean age and BMI of participants were 49.7 ± 12.6 years and 24.0 ± 3.8 kg/m2, respectively. In the study population, 20.0% (n = 17) were obese. DDS was significantly lower in obese participants than in those who were not obese (1.53 ± 0.87 vs. 2.13 ± 0.98; p = 0.029). In addition, DDS was correlated with nutrition adequacy of the diet. Multivariate analysis showed that the odds of obesity decreased with each unit increase in DDS (odds ratio, 0.278; 95% confidence interval, 0.101–0.766; p = 0.013). We conclude that patients with higher dietary diversity have a lower prevalence of obesity.
Collapse
|
|
38
|
Gaillard M, Tranchart H, Beaudreuil S, Lebrun A, Voican CS, Lainas P, Courie R, Perlemuter G, Parier B, Hammoudi Y, Durrbach A, Dagher I. Laparoscopic sleeve gastrectomy for morbid obesity in renal transplantation candidates: a matched case-control study. Transpl Int 2020; 33:1061-1070. [PMID: 32396658 DOI: 10.1111/tri.13637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/27/2020] [Accepted: 05/06/2020] [Indexed: 12/20/2022]
Abstract
Obesity has become an important issue in patients with end-stage renal disease (ESRD). Since it is considered a relative contraindication for renal transplantation, bariatric surgery has been advocated to treat morbid obesity in transplant candidates, and laparoscopic sleeve gastrectomy (LSG) is the most reported procedure. However, comparative data regarding outcomes of LSG in patients with or without ESRD are scarce. Consecutive patients with ESRD (n = 29) undergoing LSG were compared with matched patients with normal renal function undergoing LSG in a 1:3 ratio using propensity score adjustment. Data were collected from a prospective database. Eligibility for transplantation was also studied. A lower weight loss (20 kg (16-30)) was observed in patients with ESRD within the first year as compared to matched patients (28 kg (21-34)) (P < 0.05). After a median follow-up of 30 (19-50) months in the ESRD group, contraindication due to morbid obesity was lifted in 20 patients. Twelve patients underwent transplantation. In patients with ESRD potentially eligible for transplantation, LSG allows similar weight loss in comparison with matched patients with normal renal function, enabling lifting contraindication for transplantation due to morbid obesity in the majority of patients within the first postoperative year.
Collapse
Affiliation(s)
- Martin Gaillard
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, Clamart, France.,Paris-Saclay University, Orsay, France
| | - Hadrien Tranchart
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, Clamart, France.,Paris-Saclay University, Orsay, France
| | - Séverine Beaudreuil
- Paris-Saclay University, Orsay, France.,Department of Nephrology, Kremlin Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, France
| | - Amandine Lebrun
- Paris-Saclay University, Orsay, France.,Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, AP-HP, Clamart, France
| | - Cosmin Sebastian Voican
- Paris-Saclay University, Orsay, France.,Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, AP-HP, Clamart, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, Clamart, France.,Paris-Saclay University, Orsay, France
| | - Rodi Courie
- Paris-Saclay University, Orsay, France.,Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, AP-HP, Clamart, France
| | - Gabriel Perlemuter
- Paris-Saclay University, Orsay, France.,Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, AP-HP, Clamart, France
| | - Bastien Parier
- Paris-Saclay University, Orsay, France.,Department of Urology, Kremlin Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, France
| | - Yacine Hammoudi
- Paris-Saclay University, Orsay, France.,Department of Urology, Kremlin Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, France
| | - Antoine Durrbach
- Paris-Saclay University, Orsay, France.,Department of Nephrology, Kremlin Bicêtre Hospital, AP-HP, Le Kremlin Bicêtre, France.,INSERM UMRS-MD1197, Villejuif, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, AP-HP, Clamart, France
| |
Collapse
|
|
39
|
Kim SM, Choi JH, Son MJ, Rim H, Shin HS. Is Body Mass Index a Significant Independent Risk Factor for Graft Failure and Patient Death in the Modern Immunosuppressive Era? Transplant Proc 2020; 52:3058-3068. [PMID: 32475532 DOI: 10.1016/j.transproceed.2020.02.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/09/2020] [Accepted: 02/15/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Previous studies have shown that kidney transplant recipients with a high body mass index (BMI) have inferior graft and patient outcomes compared to patients with a lower BMI. We hypothesized that there would be secular improvements in outcomes among high BMI recipients. We used data from the United Network for Organ Sharing (UNOS) to determine whether obesity affects patient and graft outcomes following kidney transplantation in the modern immunosuppressive era. METHODS The study sample consisted of 69,749 recipients from 1987 to 1999 and 197,986 recipients from 2000 to 2016. BMI values were categorized into 11 tiers: below 18 kg/m2, from 18 to 36 kg/m2 at 2 kg/m2-unit increments, and above 36 kg/m2. We created multivariate models to evaluate the independent effect of BMI on graft and patient outcomes, adjusting for factors known to affect graft success and patient survival. RESULTS Overall graft and patient survival has improved for all BMI categories. Cox regression modeling hazard ratios showed that the relative risk for graft loss, patient death, and patient death with a functioning graft in the modern immunosuppressive era (2000 to 2016) has significantly decreased compared to the earlier era (1987 to 1999), especially for living kidney transplant recipients. CONCLUSIONS The relative risk of graft failure and patient death with increasing BMI has appreciably decreased in the modern immunosuppressive era, especially for living donor transplant recipients. Withholding transplantation from patients with higher BMIs may no longer be justifiable on grounds of worse clinical outcomes.
Collapse
Affiliation(s)
- Sun Min Kim
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Jae Hyuc Choi
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Mu Jin Son
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Hark Rim
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea
| | - Ho Sik Shin
- Renal Division, Department of Internal Medicine, Kosin University, College of Medicine, Busan, Republic of Korea.
| |
Collapse
|
|
40
|
Flabouris K, Chadban S, Ladhani M, Cervelli M, Clayton P. Body mass index, weight-adjusted immunosuppression and the risk of acute rejection and infection after kidney transplantation: a cohort study. Nephrol Dial Transplant 2020; 34:2132-2143. [PMID: 31168571 DOI: 10.1093/ndt/gfz095] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/15/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Body mass index (BMI) is associated with patient outcomes after kidney transplantation. We hypothesized that immunosuppression (IS) dosing is a contributing factor. METHODS Using Australia and New Zealand Dialysis and Transplant registry data, we included all adult kidney-only transplant recipients over 2000-14 treated with prednisolone, mycophenolate and tacrolimus/cyclosporin (n = 7919). The exposure was BMI and the outcomes were time to: (i) acute rejection, (ii) fatal infection, (iii) cancer and (iv) graft; and (v) patient survival. We modelled BMI and IS dosing (in quartiles) as time-varying covariates in extended Cox models. RESULTS Compared with a BMI of 25 kg/m2, a BMI of 35 was associated with acute rejection after adjusting for demographics and comorbidities [adjusted hazard ratio (aHR) = 1.29, 95% confidence interval (CI) 1.12-1.49]. This association virtually disappeared after correcting for IS (aHR = 1.09, 95% CI 0.93-1.29). A BMI of 35 was non-significantly associated with fewer fatal infections (aHR = 0.91, 95% CI 0.66-1.25), but this reversed after adjusting for IS (aHR = 1.54, 95% CI 1.03-2.28). Results for cancer were not significantly altered after adjusting for IS. Results for lower BMI were similarly not significantly altered though generally associated with worse outcomes. CONCLUSIONS Our findings show that the associations between high BMI, acute rejection and fatal infection after kidney transplantation were significantly altered after correcting for IS suggesting that relative under-dosing of obese patients may partially explain these associations.
Collapse
Affiliation(s)
- Katerina Flabouris
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia
| | - Steven Chadban
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,School of Medicine, The University of Sydney, Camperdown, Australia.,Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Maleeka Ladhani
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,School of Medicine, The University of Sydney, Camperdown, Australia.,Department of Renal Medicine, Lyell McEwin Hospital, Elizabeth Vale, Australia
| | - Matthew Cervelli
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Philip Clayton
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.,Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| |
Collapse
|
|
41
|
Diwan TS, Cuffy MC, Linares-Cervantes I, Govil A. Impact of obesity on dialysis and transplant and its management. Semin Dial 2020; 33:279-285. [PMID: 32277512 DOI: 10.1111/sdi.12876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Obesity is increasing to unprecedented levels, including in the end-stage kidney disease population, where upwards of 60% of kidney transplant patients are overweight or obese. Obesity poses additional challenges to the care of the dialysis patient, including difficulties in creating vascular access and inserting Tenckhoff catheters, higher rates of catheter malfunction and peritonitis, the need for longer and/or more frequent dialysis (or peritoneal dialysis [PD] exchanges) to achieve adequate clearance, increased metabolic complications particularly with PD, and obesity is a barrier to kidney transplantation. In this article, we review special considerations in performing PD, hemodialysis and transplant in the obese patient, as well as the evidence behind medical and surgical management of obesity in dialysis patients.
Collapse
Affiliation(s)
- Tayyab S Diwan
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Madison C Cuffy
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Ivan Linares-Cervantes
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Amit Govil
- Division of Nephrology, Department of Medicine, University of Cincinnati, Cincinnati, OH, USA
| |
Collapse
|
|
42
|
Warzyszyńska K, Zawistowski M, Karpeta E, Ostaszewska A, Jonas M, Kosieradzki M. Early Postoperative Complications and Outcomes of Kidney Transplantation in Moderately Obese Patients. Transplant Proc 2020; 52:2318-2323. [PMID: 32252995 DOI: 10.1016/j.transproceed.2020.02.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/13/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Obese renal transplant recipients (body mass index [BMI] ≥30 kg/m2) are at risk of delayed graft function and postoperative complications, such as infections or delayed wound healing. There is also a tendency to exclude extremely obese patients from transplantation (KTx). Nonetheless, no association between obesity and increased mortality has been reported. The aim of this study is to evaluate the effect of BMI on the most common surgical and infectious complications after KTx. MATERIALS AND METHODS An observational study in 872 patients transplanted from 2010-2017 was conducted. Median BMI was 24.6 (13.9-34.3), and 8.3% of the group was obese. Patient records were searched for early postoperative complications: lymphocele or hematoma (>33 mL), urinary leakage, or urinary tract infection (UTI). Mann-Whitney U and χ2 or Fisher exact tests were used. P < .05 was considered statistically significant. The study complies with the Helsinki Congress and the Istanbul Declaration. RESULTS Renal primary nonfunction was observed in 1.4% (12/872) of patients. Surgical or infectious complications occurred in 52.7% (453/860) of patients. No correlation between BMI and complication rate was noted. Complications were observed in 56.9% (41/72) of obese vs 52.3% (412/788) of nonobese patients (P = .448), including lymphocele in 15.3% vs 16.4% (P = .810), hematoma in 22.2% vs 19.2% (P = .530), urinary leakage in 1.4% vs 4.6% (P = .203), and UTI in 31.9% vs 32.9% (P = .873), respectively. CONCLUSIONS Recipient's BMI has no significant association with the most common surgical complications after KTx. There is no need to delay KTx in moderately obese patients.
Collapse
Affiliation(s)
- Karola Warzyszyńska
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - Michał Zawistowski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Edyta Karpeta
- Department of Surgical and Transplantation Nursing and Extracorporeal Therapies, Medical University of Warsaw, Warsaw, Poland
| | - Agata Ostaszewska
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Maurycy Jonas
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
|
43
|
Pinar U, Renard Y, Bedretdinova D, Parier B, Hammoudi Y, Irani J, Bessede T. Temporary contraindication of obese recipients in kidney transplantation: A new morphometric tool for decision support. Clin Transplant 2020; 34:e13829. [PMID: 32065442 DOI: 10.1111/ctr.13829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/29/2020] [Accepted: 02/13/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Morbid obesity, based on body mass index (BMI) and/or clinical examination, can be a temporary contraindication (TCI) of kidney transplantation. However, BMI alone does not evaluate the intra- or extra-peritoneal distribution of fatty tissue, and clinical examination alone is subjective. The objective was to evaluate the interest of morphometric criteria to ensure reproducible and consensual decision of TCI. METHODS We retrospectively included patients with a BMI >30 transplanted or temporarily contraindicated because of their weight from 2012 to 2017. The following measurements were performed on CT scan sections using a semiautomatic Hounsfield density detection software: subcutaneous adipose tissue surface (SAT), visceral adipose tissue surface (VAT), vessel-to-skin distance (VSK), abdominal perimeter (AP), and psoas index. Performance of morphometric measures to predict TCI was assessed through ROC analysis. RESULTS Ninety-seven patients were included: 76 kidney transplant recipients and 21 on the TCI list. The area under the curve (AUC, 95%CI) for the BMI model to predict TCI was 0.81 (0.72-0.90). A 5-variable model including BMI, VAT, VSK, AP, and age gave an AUC of 0.88 (0.78-0.98). CONCLUSIONS Morphometric obesity parameters are associated with TCI decision-making for kidney transplantation: When combined with BMI in a "morphometric tool," they were predictive of a TCI decision.
Collapse
Affiliation(s)
- Ugo Pinar
- Department of Urology, Hôpital Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Yohann Renard
- Department of Visceral Surgery, Champagne-Ardenne University, Robert Debré University Hospital, Reims, France
| | - Dina Bedretdinova
- Gender, sexual and reproductive health, CESP Centre for research in Epidemiology and Population Health, U1018, INSERM, Le Kremlin-Bicêtre, France
| | - Bastien Parier
- Department of Urology, Hôpital Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Yacine Hammoudi
- Department of Urology, Hôpital Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Jacques Irani
- Department of Urology, Hôpital Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Thomas Bessede
- Department of Urology, Hôpital Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, INSERM, Le Kremlin-Bicêtre, France
| |
Collapse
|
|
44
|
Swanson KJ, Joachim E, Arunachalam A, Aziz F, Garg N, Mohamed M, Djamali A, Redfield RR, Kaufman DB, Odorico J, Mandelbrot D, Parajuli S. Incidence and Outcomes of Significant Weight Changes After Pancreas Transplant Alone. Transplant Direct 2020; 6:e539. [PMID: 32195330 PMCID: PMC7056274 DOI: 10.1097/txd.0000000000000983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/29/2019] [Accepted: 01/03/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Weight change, primarily weight gain, is a common problem among solid organ transplant recipients. The incidence of weight gain or loss after successful pancreas transplant alone (PTA) and the effect on graft survival is unknown. METHODS This was a single-center observational study among PTA recipients, transplanted at our center between January 1, 2005, and July 31, 2017, who had a functional pancreas graft for at least 1 year and documented weight change at the 1-year clinic visit. RESULTS In this cohort study of 105 PTA recipients, 28 had significant weight gain, 27 had significant weight loss, and the remaining 50 did not have significant weight change at 1-year posttransplant. When comparing the weight gain and no weight change groups, the weight gain cohort started to gain weight at 3 months posttransplant to 5 years or last follow up. Similarly, the weight loss group lost weight at 3 months posttransplant up to last follow up. Clinically significant weight gain or weight loss were not associated with uncensored or death censored graft failure in univariate regression and Kaplan-Meier survival analysis. Also, there were no significant differences between the groups in the glycated hemoglobin at last follow up. CONCLUSIONS Approximately 50% of PTA recipients had a significant weight change at 1-year posttransplant, of which 25% gained significant weight and 25% loss. There was no significant difference in graft survival due to the significant weight changes. Further research is needed in this field.
Collapse
Affiliation(s)
- Kurtis J. Swanson
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Emily Joachim
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Annamalai Arunachalam
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Maha Mohamed
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Arjang Djamali
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Division of Transplant Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Robert R. Redfield
- Division of Transplant Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Dixon B. Kaufman
- Division of Transplant Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jon Odorico
- Division of Transplant Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Didier Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|
|
45
|
Kassam AF, Mirza A, Kim Y, Hanseman D, Woodle ES, Quillin RC, Johnson BL, Govil A, Cardi M, Schauer DP, Smith EP, Diwan TS. Long-term outcomes in patients with obesity and renal disease after sleeve gastrectomy. Am J Transplant 2020; 20:422-429. [PMID: 31605562 DOI: 10.1111/ajt.15650] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/06/2019] [Accepted: 10/03/2019] [Indexed: 01/25/2023]
Abstract
Morbid obesity is a barrier to kidney transplant in patients with end-stage renal disease (ESRD). Laparoscopic sleeve gastrectomy (SG) is an increasingly considered intervention, but the safety and long-term outcomes are uncertain. We reviewed prospectively collected data on patients with ESRD and chronic kidney disease (CKD) undergoing SG from 2011 to 2018. There were 198 patients with ESRD and 45 patients with CKD (stages 1-4) who met National Institutes of Health guidelines for bariatric surgery and underwent SG; 72% and 48% achieved a body mass index of ≤ 40 and ≤ 35 kg/m2 , respectively. The mean percentages of total weight loss and excess weight loss were 18.9 ± 10.8% and 38.2 ± 20.3%, respectively. SG reduced hypertension (85.8% vs 52.1%), decreased antihypertensive medication use (1.6 vs 1.0) (P < .01 each), and reduced incidence of diabetes (59.6% vs 32.5%, P < .01). Of the 71 patients with ESRD who achieved a body mass index of ≤ 40 kg/m2 , 45 were waitlisted and received a kidney transplant, whereas 10 remain on the waitlist. Mortality rate after SG was 1.8 per 100 patient-years, compared with 7.3 for non-SG. Patients with stage 3a or 3b CKD exhibited improved glomerular filtration rate (43.5 vs 58.4 mL/min, P = .01). In conclusion, SG safely improves transplant candidacy while providing significant, sustainable effects on weight loss, reducing medical comorbidities, and possibly improving renal function in stage 3 patients.
Collapse
Affiliation(s)
- Al-Faraaz Kassam
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Ahmad Mirza
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Young Kim
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Dennis Hanseman
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - E Steve Woodle
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Ralph C Quillin
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Bobby L Johnson
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Amit Govil
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Michael Cardi
- Department of Internal Medicine, The Christ Hospital, Cincinnati, Ohio
| | - Daniel P Schauer
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Eric P Smith
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Tayyab S Diwan
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| |
Collapse
|
|
46
|
Guzmán GE, Victoria AM, Ramos I, Maldonado A, Manzi E, Contreras-Valero JF, Mesa L, Schweineberg J, Posada JG, Villegas JI, Caicedo LA, Durán CE. Risk Factors Related to New-Onset Diabetes after Renal Transplantation in Patients of a High Complexity University Hospital in Colombia, 20 Years of Experience. Int J Endocrinol 2020; 2020:8297192. [PMID: 32908503 PMCID: PMC7477588 DOI: 10.1155/2020/8297192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/13/2020] [Accepted: 08/01/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION New-onset diabetes after transplantation (NODAT) is associated with immunosuppression. Its complications can negatively influence patients' quality of life, which is why it is important to study the associated risk factors and expand the possible therapies in this particular group of patients. Materials and methods. Case-control study nested in a retrospective cohort. It included patients who received kidney transplantation at the high complexity University Hospital Fundación Valle del Lili in Cali, Colombia, between 1995 and 2014. Two controls were assigned for each case, depending on the type of donor and the date of the surgery. Information was collected from clinical records and the institutional TRENAL registry. We carried out a descriptive analysis of the selected variables and identified the risk factors with conditional logistic regression. RESULTS 122 cases were identified to which 224 controls were assigned. The median age was 44 years (IQR: 34-55), and 54% were men. Having >50 years of age at the time of transplantation (OR: 3.18, 95% CI: 1.6-6.3, p = 0.001), body mass index >30 kg/m2 (OR: 3.6, 95% CI: 1.3-9.7, p = 0.010) and being afro-descendant (OR: 2.74, 95% CI: 1.1-6.5, p = 0.023) were identified as risk factors for the development of NODAT. Pretransplant fasting plasma glucose >100 mg/dl (OR: 2.9, 95% CI: 1.4-6.4, p = 0.005) and serum triglycerides >200 mg/dl (OR: 2.5, 95% CI: 1.4-4.4, p = 0.002) were also reported as independent risk factors. CONCLUSION We ratify some risk factors for the development of this important disease, which include certain modifiable characteristics. Interventions aimed at changes in lifestyle could be established in a timely manner before transplant surgery.
Collapse
Affiliation(s)
- Guillermo E. Guzmán
- Fundación Valle del Lili, Departamento de Endocrinología, Cra 98, No. 18-49, Cali 760032, Colombia
- Universidad Icesi, Facultad de Ciencias de la Salud, Calle 18, No. 122-135, Cali, Colombia
| | - Angela M. Victoria
- Universidad Icesi, Facultad de Ciencias de la Salud, Calle 18, No. 122-135, Cali, Colombia
| | - Isabella Ramos
- Universidad Icesi, Facultad de Ciencias de la Salud, Calle 18, No. 122-135, Cali, Colombia
| | - Alejandro Maldonado
- Universidad Icesi, Facultad de Ciencias de la Salud, Calle 18, No. 122-135, Cali, Colombia
| | - Eliana Manzi
- Fundación Valle del Lili, Centro de Investigaciones Clínicas, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Juan F. Contreras-Valero
- Universidad Icesi, Facultad de Ciencias de la Salud, Calle 18, No. 122-135, Cali, Colombia
- Fundación Valle del Lili, Departamento de Medicina Interna, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Liliana Mesa
- Fundación Valle del Lili, Departamento de Nefrología–Unidad de Trasplantes, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Johanna Schweineberg
- Fundación Valle del Lili, Departamento de Nefrología–Unidad de Trasplantes, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Juan G. Posada
- Fundación Valle del Lili, Departamento de Nefrología–Unidad de Trasplantes, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Jorge I. Villegas
- Fundación Valle del Lili, Departamento de Nefrología–Unidad de Trasplantes, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Luis A. Caicedo
- Fundación Valle del Lili, Departamento de Nefrología–Unidad de Trasplantes, Cra 98, No. 18-49, Cali 760032, Colombia
| | - Carlos E. Durán
- Fundación Valle del Lili, Departamento de Nefrología–Unidad de Trasplantes, Cra 98, No. 18-49, Cali 760032, Colombia
| |
Collapse
|
|
47
|
Tiwari R, Lyu B, Alagusundaramoorthy S, Astor BC, Mandelbrot DA, Parajuli S. Association of diagnosed obstructive sleep apnea with kidney transplant outcomes. Clin Transplant 2019; 33. [PMID: 31665552 DOI: 10.1111/ctr.13747] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/11/2019] [Accepted: 10/26/2019] [Indexed: 12/30/2022]
Abstract
Obstructive sleep apnea (OSA) is common but underdiagnosed among patients with kidney disease. This study examines whether the diagnosis of OSA in kidney transplant recipients (KTR) affected death, death-censored graft failure (DCGF), and acute rejection (AR). We analyzed the records of KTR who underwent transplant between 2000 and 2015. A total of 4014 kidney transplants were performed during the study period. Of these, 415 (10.3%) had a diagnosis of pretransplant OSA. Pretransplant OSA was associated with a higher risk of death in unadjusted analyses. After adjustment for potential confounders, pretransplant OSA was not associated with risk of death (HR = 1.04, 95% CI: 0.80-1.36). Similarly, pretransplant OSA was associated with a slightly higher incidence of DCGF or AR but neither associations were significant (HR: 1.23, 95% CI: 0.85-1.47 for DCGF; HR 1.10, 95% CI: 0.90-1.36 for AR). A total of 117 (3.3%) were diagnosed with de novo OSA after transplant. Similar to the pretransplant OSA, unadjusted HR for death was significantly higher in the de novo OSA group (HR: 1.48, 95% CI: 1.19-1.84); however, after adjustment, de novo OSA was not significantly associated with risk of death (HR: 1.15, 95% CI: 0.92-1.45). Similarly, DCGF and AR rates were not significantly associated with de novo OSA (HR: 1.10, 95% CI: 0.84-1.44 for DCGF; HR 1.10, 95% CI: 0.90-1.33 for AR). Our work did not detect significant associations between OSA and risk of death, graft failure, and rejection but the estimates might be underestimated due to underdiagnosis of OSA.
Collapse
Affiliation(s)
- Rachna Tiwari
- Division of Pulmonology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Beini Lyu
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sayee Alagusundaramoorthy
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Brad C Astor
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
|
48
|
Abstract
Advancement in kidney transplantation has led to prolonged survival in our population with kidney disease. Newer agents of immunosuppression have made this possible with less rejections and lesser opportunistic infections and transplant related deaths. Preventative care like timely vaccines, cancer screenings, aggressive blood pressure, blood sugar, lipid control, timely referral to consultants is required in these patient population to provide quality care and to prolong their survival. Primary care physicians are the best advocate for our transplant populations. To care for these complex transplant patients, it is vital for primary care physicians to be familiar with the overall approach on our patients.
Collapse
Affiliation(s)
- Kavitha Ramaswamy
- Thomas Jefferson University Hospital, Division of Nephrology, 833 Chestnut St, Suite 700, Philadelphia, PA 19107, USA.
| | - Hector M Madariaga
- Good Samaritan Medical Center, Department of Medicine, 235N Pearl St, Brockton, MA 02301, USA
| | - Beje S Thomas
- Georgetown University Medical Center, MedStar Georgetown Transplant Institute, 3800 Reservoir Road, Washington, DC 20007 USA
| | - Edgar V Lerma
- University of Illinois at Chicago College of Medicine/ Advocate Christ Medical Center, Oak Lawn, IL, USA
| |
Collapse
|
|
49
|
Matas AJ, Vock DM. Prednisone‐free maintenance immunosuppression in obese kidney transplant recipients. Clin Transplant 2019; 33:e13668. [DOI: 10.1111/ctr.13668] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/24/2019] [Accepted: 07/10/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Arthur J. Matas
- Division of Transplantation, Department of Surgery, Medical School University of Minnesota Minneapolis MN USA
| | - David M. Vock
- Division of Biostatistics, School of Public Health University of Minnesota Minneapolis MN USA
| |
Collapse
|
|
50
|
Bellini MI, Paoletti F, Herbert PE. Obesity and bariatric intervention in patients with chronic renal disease. J Int Med Res 2019; 47:2326-2341. [PMID: 31006298 PMCID: PMC6567693 DOI: 10.1177/0300060519843755] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/23/2019] [Indexed: 12/25/2022] Open
Abstract
Obesity is associated with chronic metabolic conditions that directly and indirectly cause kidney parenchymal damage. A review of the literature was conducted to explore existing evidence of the relationship between obesity and chronic kidney disease as well as the role of bariatric surgery in improving access to kidney transplantation for patients with a high body mass index. The review showed no definitive evidence to support the use of a transplant eligibility cut-off parameter based solely on the body mass index. Moreover, in the pre-transplant scenario, the obesity paradox is associated with better patient survival among obese than non-obese patients, although promising results of bariatric surgery are emerging. However, until more information regarding improvement in outcomes for obese kidney transplant candidates is available, clinicians should focus on screening of the overall frailty condition of transplant candidates to ensure their eligibility and addition to the wait list.
Collapse
Affiliation(s)
- Maria Irene Bellini
- Renal and Transplant Directorate, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
| | | | - Paul Elliot Herbert
- Renal and Transplant Directorate, Hammersmith Hospital, Imperial College NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
- Imperial College, London, United Kingdom
| |
Collapse
|