Elsevier

Seminars in Nephrology

Volume 33, Issue 1, January 2013, Pages 34-43
Seminars in Nephrology

Obesity and Kidney Transplantation

https://doi.org/10.1016/j.semnephrol.2012.12.007Get rights and content

Summary

Obesity confers increased risk for graft loss and death among renal transplant recipients. However the relationship of changes in body weight and composition to outcome on the transplant waitlist and post-transplantation is not straightforward. Strategies to manage weight in the waitlisted patient and after kidney transplantation must be performed in the context of a multidisciplinary approach and individualized based on risk factors in particular patients. Although retrospective studies offer considerable insights into the relationship between obesity and kidney transplant outcome, causal inferences must be made with great caution.

Section snippets

Definitions

Obesity is a pathophysiologic state characterized by excessive adipose tissue mass. In the medical context, obesity may be defined as a state of increased body weight, more specifically, adipose tissue, of sufficient magnitude to impact adversely on health. The most widely accepted classification of obesity is based on body mass index (BMI), defined as body weight in kilograms (kg) divided by height in meters squared (m2). BMIs between 18.5 and 24.9 kg/m2 represent normal weight, BMIs between

Epidemiology

The prevalence of obesity continues to increase globally and in developed countries it can be as high as 20%.6 Sedentary lifestyles, cultural and behavioral factors, and dietary indiscretion are the two most common explanations for the burgeoning epidemic of obesity. The prevalence of obesity in the kidney transplant population has increased; the proportion of renal transplant recipients classified as obese has more than doubled.1 The increasing prevalence of obesity in the renal transplant

Pathophysiologic Considerations

In the general population, obesity portends poor health and longevity because it is an independent risk factor for cardiovascular disease and clusters almost inextricably with other risk factors for cardiovascular disease and progressive renal insufficiency such as hypertension, hyperlipidemia, and insulin resistance.9 Obesity also is associated independently with abnormalities of coronary circulation in the population at large.9 Obesity has been linked to the development of focal and segmental

Perioperative Complications

In the general population, obesity does increase the risk of perioperative complications such as deep vein thrombosis, delayed wound healing, wound infections, and hernias.16 These risks logically can be expected to transfer to ESRD patients with the reasonable expectation that malnutrition, immunosuppression, and co-existing cardiovascular morbidity could compound the overall risk.

Humar et al17 studied 2,013 renal transplant recipients at the University of Minnesota and found a 4.4-fold risk

Early Complications

Delayed graft function and acute rejection are two significant complications in the early post-transplant period.

The role of obesity in the development of delayed graft function (DGF) (usually defined as the requirement for dialysis in the first week after renal transplantation) is uncertain. Single-center studies of cadaveric renal transplantation showed an increased DGF risk with BMIs exceeding 36 kg/m2. Explanations for the association between recipient obesity and DGF include prolonged

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