Ugo Pinar1, Arthur Mageau2, Yohann Renard3, Xavier Rod4, Cédric Lebacle5, Benoit Barrou4, Mohamad Zaidan6, Jacques Irani5, Thomas Bessede5,7. 1. Department of Urology and Transplantation Surgery, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, 78 rue du général Leclerc, Le Kremlin-Bicêtre, 94270, Paris, France. ugopinar@gmail.com. 2. Department of Internal Medicine, Hôpital Henri Mondor, AP-HP, Université Paris Saclay, Créteil, 94010, Paris, France. 3. Department of Visceral Surgery, Reims, Champagne-Ardenne University, Robert Debré University Hospital, Reims, France. 4. Department of Urology and Kidney Transplantation, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, AP-HP. Sorbonne Université, 75013, Paris, France. 5. Department of Urology and Transplantation Surgery, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, 78 rue du général Leclerc, Le Kremlin-Bicêtre, 94270, Paris, France. 6. Department of Nephrology, Hôpital de Bicêtre, AP-HP. Université Paris Saclay, Le Kremlin-Bicêtre, 94270, Paris, France. 7. U1195, Université Paris-Saclay, Inserm, Le Kremlin-Bicêtre, 94276, Paris, France.
Abstract
PURPOSE: Adipose distribution and sarcopenia could better assess kidney transplantation outcomes than body mass index (BMI) and have been poorly evaluated among obese and overweight recipients. We aimed to evaluate morphometric radiologic markers to predict post-operative dialysis within this population. METHODS: We conducted a retrospective study including patients with a BMI > 25 kg/m2 undergoing kidney transplantation during 5 years. Subcutaneous adipose tissue surface (SAT), visceral adipose tissue surface (VAT), and psoas surface were measured on CT scans sections. A model predictive of post-transplantation dialysis was elaborated through a multivariable logistic regression and was compared to a model including only BMI. RESULTS: Overall, 248 patients were included whom mean (SD) BMI and age were, respectively, 29.7 kg/m2 (3.6) and 56 years (12.7). Of them, 83 (33.5%) needed dialysis: 14 (5.7%) for primary kidney failure and 69 (27.8%) for delayed kidney function. On multivariable analysis, SAT, VAT and deceased donor were significantly associated with post-operative dialysis (respectively, OR [95%CI]:1.6 [1.1-2.6], 1.6[1.1-2.6], and 7.5 [1.6-56]). The area under the curve of this predictive model was 0.70 versus 0.64 for a BMI-based model. CONCLUSION: High VAT and SAT were associated with post-transplantation dialysis. A predictive model based on these morphometrics could provide a better appreciation of graft recovery after transplantation among obese and overweight recipients. External validation is needed.
PURPOSE: Adipose distribution and sarcopenia could better assess kidney transplantation outcomes than body mass index (BMI) and have been poorly evaluated among obese and overweight recipients. We aimed to evaluate morphometric radiologic markers to predict post-operative dialysis within this population. METHODS: We conducted a retrospective study including patients with a BMI > 25 kg/m2 undergoing kidney transplantation during 5 years. Subcutaneous adipose tissue surface (SAT), visceral adipose tissue surface (VAT), and psoas surface were measured on CT scans sections. A model predictive of post-transplantation dialysis was elaborated through a multivariable logistic regression and was compared to a model including only BMI. RESULTS: Overall, 248 patients were included whom mean (SD) BMI and age were, respectively, 29.7 kg/m2 (3.6) and 56 years (12.7). Of them, 83 (33.5%) needed dialysis: 14 (5.7%) for primary kidney failure and 69 (27.8%) for delayed kidney function. On multivariable analysis, SAT, VAT and deceased donor were significantly associated with post-operative dialysis (respectively, OR [95%CI]:1.6 [1.1-2.6], 1.6[1.1-2.6], and 7.5 [1.6-56]). The area under the curve of this predictive model was 0.70 versus 0.64 for a BMI-based model. CONCLUSION: High VAT and SAT were associated with post-transplantation dialysis. A predictive model based on these morphometrics could provide a better appreciation of graft recovery after transplantation among obese and overweight recipients. External validation is needed.
Authors: Gregory Xiang Wen Pek; Clara Lee Ying Ngoh; Boon Wee Teo; Anantharaman Vathsala; Benjamin Yen Seow Goh; Clement Hsiang Rong Yong; Lata Raman; Ho Yee Tiong Journal: World J Urol Date: 2018-11-19 Impact factor: 4.226