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HomeNephrology Dialysis Transplantationindex/list_12275_1Impact of Obesity in Kidney Transplantation

Impact of Obesity in Kidney Transplantation

Abstract and Introduction

Abstract

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Background: The access of obese patients to kidney transplantation is limited despite several studies showing that obese transplant recipients had a better survival rate than those undergoing dialysis. The aim of this study was to compare patient and graft survival rates and post-renal transplant complications in obese patients and non-obese patients and to assess the effect of pre-transplant weight loss in obese patients on transplant outcomes.

Methods: We carried out a prospective cohort study using two French registries, the Renal Epidemiology and Information Network and CRISTAL, on 7270 kidney transplant patients between 2008 and 2014 in France. We compared obese patients with non-obese patients and obese patients who lost more than 10% of weight before the transplant (obese WL and obese nWL).

Results: The mean BMI in our obese patients was 32 kg/m2. Graft survival was lower in obese patients than in non-obese patients {hazard ratio (HR) = 1.40, [95% confidence interval (95% CI) 1.09; 1.78], P = 0.007}, whereas patient survival was similar [HR = 0.94, (95% CI 0.73; 1.23), P = 0.66]. Graft survival was significantly lower in obese WL than in obese nWL [HR = 2.17, (1.02; 4.63), P = 0.045], whereas patient survival was similar in the two groups [HR = 0.79, (0.35; 1.77), P = 0.56].

Conclusion: Grade 1 obesity does not seem to be a risk factor for excess mortality after kidney transplantation and should not be an obstacle to having access to a graft. Weight loss before a kidney transplant in these patients should not be essential for registration on waiting list.

Introduction

Since the early 2000s, the prevalence of obesity in the Western world has been increasing annually.[1] Obesity and its complications, in particular cardiovascular and metabolic disorders, increase the risk of chronic kidney disease.[2–5] The prevalence of the disease in France in 2015 was 22% in dialysis patients[6] versus 17% in the general population.[7] The access of these obese patients to kidney transplantation is limited despite several studies showing that obese transplant recipients had a better survival rate than those undergoing dialysis.[8–12] In France, although the High Authority for Health recommends offering renal transplants to patients with a body mass index (BMI) greater than 50 kg/m2,[13] most transplant teams prefer potential recipients to have a BMI lower than 35 kg/m2. Hence, obese patients are encouraged to lose weight before receiving a graft or being placed on a transplant waiting list.

Most relevant studies have shown that obese renal transplant recipients have more complications postoperatively and during the first year of graft than non-obese patients.[14–27] However, obese patient and graft survival rates differ between reports.

Of the few studies investigating the effect of weight loss before transplantation on graft outcome in obese patients, most were performed in the USA.[31–33] A preliminary study based on data from a French transplant centre showed that obesity and weight loss pre-transplant had no effect on graft outcome and patient survival.[34]

The aim of this new study was to compare patient and graft survival rates and post-renal transplant complications in obese patients and non-obese patients and to assess the effect of pre-transplant weight loss in obese patients on transplant outcomes using data from French national registries.

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