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

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.