Obesity and Kidney Transplantation
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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Cited by (14)
Sleeve Gastrectomy Compared with Gastric Bypass for Morbidly Obese Patients with End Stage Renal Disease: a Decision Analysis
2020, Journal of Gastrointestinal SurgeryImpact of Obesity on Renal Graft Function—Analysis of Kidney Grafts From the Same Donor
2016, Transplantation ProceedingsHigh prevalence of obesity in Thai renal transplant recipients: A multicenter study
2014, Transplantation ProceedingsMorbid Obesity Is Not an Independent Predictor of Graft Failure or Patient Mortality After Kidney Transplantation
2014, Journal of Renal NutritionCitation Excerpt :However, 99% of all centers set absolute weight limits for transplant, with most using body mass index (BMI) greater than 35 kg/m2 as the criteria for noneligibility.3,4 This practice is prevalent because obesity is widely believed to be associated with greater patient and graft mortality, and centers are largely judged on these outcomes.5,6 Analysis of national databases show that obesity is associated with decreased patient and graft survival after kidney transplant.7,8
Absolute Nephrology Review: An Essential Q & A Study Guide, Second Edition
2022, Absolute Nephrology Review: An Essential Q & A Study Guide, Second Edition
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