Is Pretransplantation Overweight and Obesity still a Nightmare for Kidney Transplantation Outcomes?

João Carvalho; Pedro Nunes; Hugo Antunes; Edgar Tavares-da-Silva; Belmiro Parada; António Roseiro; Carlos Ferreira; Arnaldo Figueiredo

doi:10.24915/aup.35.3-4.87

Authors

João Carvalho Urology and Renal Transplantation Department of the Coimbra University Hospital Center, Coimbra, Portugal
Pedro Nunes Urology and Renal Transplantation Department of the Coimbra University Hospital Center, Coimbra, Portugal
Hugo Antunes Urology and Renal Transplantation Department of the Coimbra University Hospital Center, Coimbra, Portugal
Edgar Tavares-da-Silva Urology and Renal Transplantation Department of the Coimbra University Hospital Center, Coimbra, Portugal
Belmiro Parada Urology and Renal Transplantation Department of the Coimbra University Hospital Center, Coimbra, Portugal
António Roseiro Urology and Renal Transplantation Department of the Coimbra University Hospital Center, Coimbra, Portugal
Carlos Ferreira Urology and Renal Transplantation Department of the Coimbra University Hospital Center, Coimbra, Portugal
Arnaldo Figueiredo Urology and Renal Transplantation Department of the Coimbra University Hospital Center, Coimbra, Portugal

DOI:

https://doi.org/10.24915/aup.35.3-4.87

Keywords:

Body Mass Index, Kidney Transplantation, Obesity, Overweight, Treatment Outcome

Abstract

Introduction: Obesity is an increasingly common disease in patients with end-stage chronic kidney disease candidates for renal transplantation. It is an important factor that should be addressed in the period before renal transplantation. The aim of this study is to evaluate the impact of pretransplantation body mass index (BMI) in graft and recipient outcomes.

Material and Methods: An observational retrospective analysis of 913 kidney transplantations was performed between September 2010 and May 2017. Recipients were categorized in groups: obesity (group 1), overweight (group 2) and normal BMI (group 3). A preoperative protocol was used: recipient and donor characteristics, perioperative data, graft and patient survival were evaluated. The software used was IBM SPSS Statistics 23: p value of < 0.05 was considered statiscally significant.

Results: Overweight was observed in 36.2% and obesity in 12.3%. In groups 1 and 2, there was a higher prevalence of type II diabetes mellitus compared with group 3 (17.9%, 16.4%, 6.6%, respectively, p < 0.001). Recipient creatinine serum levels at first and third months were also statistically different. Both groups 1 and 2 showed higher surgery duration and postoperative length of stay. It was noticed a lower immediate diuresis rate in group 1 (63.2%) and in group 2 (80.4%), p < 0.0001. Perioperative complications were more prevalent in groups 1 and 2, especially lymphocele formation (21.4% and 7.7%, respectively, versus 3.6%) and wound dehiscence (21.4% and 5.8%, respectively, versus 1.2%), p < 0.05. No statistically differences were seen in graft and patient survival.

Conclusion: Pretransplantation weight is important in renal transplantation: worse renal function in the first and third months, longer surgery duration and postoperative length of stay, higher delayed graft function rate and a higher prevalence of lymphocele formation and wound dehiscence were noticed in both non-normal weight groups. However, obese and overweight groups showed similar survival and long-term outcome comparing with normal BMI recipients.

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