Hindsight: Obesity As a Risk Factor In Kidney Transplant Recipients

Professor Dr. med. Tobias Pischon, Max-Delbruck Centre, Charité Berlin, Germany

Professor Dr. med. Tobias Pischon, Max-Delbruck Centre, Charité Berlin, Germany

Continuing my review of past papers on obesity, here is one that I am particularly fond of, as there was rather limited information on this topic at the time – namely the impact of obesity on kidney transplant recipients

The paper, published in Nephrology, Dialysis, & Transplantation in 2001, was authored by my doctoral student Tobias Pischon, who is now Professor for Molecular Epidemiology at the Charité Berlin and Head of the Molecular Epidemiology Group of the Max-Delbrück-Center for Molecular Medicine (MDC) Berlin-Buch.

In our systematic review, we identified nine relevant studies with patient follow‐up ranging from 24 to 120 months in a total of 2791 kidney transplant patients.

As could perhaps be expected, obese transplant recipients were more likely to experience a wide range of problem including systematic and wound infections, gastrointestinal problems, wound complications, admission to intensive care for cardiac and pulmonary complications, urological problems, new-onset diabetes, hypertension, phlebitis, and leg ulcers.

While obesity did not appear to affect acute rejection, there were some reports on delayed graft function possibly related to longer operation times or urological complications.

Virtually all investigators reported a somewhat (but not dramatically) lower graft survival in obese compared with non‐obese renal transplant recipients, with differences appearing as early as 1 year post-transplantation. According to one report, obese patients were also more likely to die earlier even with a functioning graft.

We also found consistent reports on marked increase in body weight post transplant (often a side effect of steroid medication) with obese patients often gaining more weight than normal weight patients resulting in more diabetes and cardiac problems.

From these findings we concluded that:

“Obesity is commonly present in patients undergoing renal transplantation and is significantly associated with a higher overall mortality and reduced allograft survival. Obese patients experience a greater incidence of perioperative complications, often resulting in delayed graft function, early graft loss and, in some cases, delayed discharge from hospital. In contrast, immunological complications of transplantation are apparently not related to body weight. A substantial proportion of transplant patients experience a marked increase in body weight following transplantation and obesity remains a significant cause of diabetes and cardiac complications in this population.”

In the past 10 years, with the continuing increase in obesity, both pre- and post-transplant obesity remains a significant issue in patients with end stage kidney failure.

According to Google Scholar, this paper has been cited 46 times.

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