Christopher J Hill1, Aisling E Courtney1, Christopher R Cardwell2, Alexander P Maxwell1, Giuseppe Lucarelli3, Massimiliano Veroux4, Frederico Furriel5, Robert M Cannon6, Ellen K Hoogeveen7, Mona Doshi8, Jennifer A McCaughan1. 1. Regional Nephrology Unit, Belfast City Hospital, Belfast, UK. 2. Centre for Public Health, Queen's University Belfast, Belfast, UK. 3. Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy. 4. Vascular Surgery and Organ Transplant Unit, University of Catania, Catania, Italy. 5. Department of Urology and Renal Transplantation, University Hospital, Coimbra, Portugal. 6. Department of Surgery, University of Louisville, Louisville, KY, USA. 7. Department of Nephrology, Leiden University Medical Centre, Leiden, The Netherlands. 8. Department of Internal Medicine, Wayne State University, Detroit, MI, USA.
Abstract
BACKGROUND: The prevalence of obesity is increasing globally and is associated with chronic kidney disease and premature mortality. However, the impact of recipient obesity on kidney transplant outcomes remains unclear. This study aimed to investigate the association between recipient obesity and mortality, death-censored graft loss and delayed graft function (DGF) following kidney transplantation. METHODS: A systematic review and meta-analysis was conducted using Medline, Embase and the Cochrane Library. Observational studies or randomized controlled trials investigating the association between recipient obesity at transplantation and mortality, death-censored graft loss and DGF were included. Obesity was defined as a body mass index (BMI) of ≥30 kg/m(2). Obese recipients were compared with those with a normal BMI (18.5-24.9 kg/m(2)). Pooled estimates of hazard ratios (HRs) for patient mortality or death-censored graft loss and odds ratios (ORs) for DGF were calculated. RESULTS: Seventeen studies including 138 081 patients were analysed. After adjustment, there was no significant difference in mortality risk in obese recipients [HR = 1.24, 95% confidence interval (CI) = 0.90-1.70, studies = 5, n = 83 416]. However, obesity was associated with an increased risk of death-censored graft loss (HR = 1.06, 95% CI = 1.01-1.12, studies = 5, n = 83 416) and an increased likelihood of DGF (OR = 1.68, 95% CI = 1.39-2.03, studies = 4, n = 28 847). CONCLUSIONS: Despite having a much higher likelihood of DGF, obese transplant recipients have only a slightly increased risk of graft loss and experience similar survival to recipients with normal BMI.
BACKGROUND: The prevalence of obesity is increasing globally and is associated with chronic kidney disease and premature mortality. However, the impact of recipient obesity on kidney transplant outcomes remains unclear. This study aimed to investigate the association between recipient obesity and mortality, death-censored graft loss and delayed graft function (DGF) following kidney transplantation. METHODS: A systematic review and meta-analysis was conducted using Medline, Embase and the Cochrane Library. Observational studies or randomized controlled trials investigating the association between recipient obesity at transplantation and mortality, death-censored graft loss and DGF were included. Obesity was defined as a body mass index (BMI) of ≥30 kg/m(2). Obese recipients were compared with those with a normal BMI (18.5-24.9 kg/m(2)). Pooled estimates of hazard ratios (HRs) for patient mortality or death-censored graft loss and odds ratios (ORs) for DGF were calculated. RESULTS: Seventeen studies including 138 081 patients were analysed. After adjustment, there was no significant difference in mortality risk in obese recipients [HR = 1.24, 95% confidence interval (CI) = 0.90-1.70, studies = 5, n = 83 416]. However, obesity was associated with an increased risk of death-censored graft loss (HR = 1.06, 95% CI = 1.01-1.12, studies = 5, n = 83 416) and an increased likelihood of DGF (OR = 1.68, 95% CI = 1.39-2.03, studies = 4, n = 28 847). CONCLUSIONS: Despite having a much higher likelihood of DGF, obese transplant recipients have only a slightly increased risk of graft loss and experience similar survival to recipients with normal BMI.
Authors: Meera Nair Harhay; Karthik Ranganna; Suzanne M Boyle; Antonia M Brown; Thalia Bajakian; Lissa B Levin Mizrahi; Gary Xiao; Stephen Guy; Gregory Malat; Dorry L Segev; David Reich; Mara McAdams-DeMarco Journal: Am J Kidney Dis Date: 2019-05-21 Impact factor: 8.860
Authors: Rashikh A Choudhury; Gerard Hoeltzel; Kas Prins; Eric Chow; Hunter B Moore; Peter J Lawson; Dor Yoeli; Akshay Pratap; Peter L Abt; Kristoffel R Dumon; Kendra D Conzen; Trevor L Nydam Journal: J Gastrointest Surg Date: 2019-05-01 Impact factor: 3.452
Authors: Juliane Liese; Nils Bottner; Stefan Büttner; Alexander Reinisch; Guido Woeste; Markus Wortmann; Ingeborg A Hauser; Wolf Otto Bechstein; Frank Ulrich Journal: Langenbecks Arch Surg Date: 2017-05-10 Impact factor: 3.445
Authors: Kyle H Sheetz; Kenneth J Woodside; Vahakn B Shahinian; Justin B Dimick; John R Montgomery; Seth A Waits Journal: Clin J Am Soc Nephrol Date: 2019-07-25 Impact factor: 8.237
Authors: Jordana B Cohen; Mary Ann Lim; Colleen M Tewksbury; Samuel Torres-Landa; Jennifer Trofe-Clark; Peter L Abt; Noel N Williams; Kristoffel R Dumon; Simin Goral Journal: Surg Obes Relat Dis Date: 2019-06 Impact factor: 4.734