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UK renal transplant outcomes in low and high BMI recipients: the need for a national policy

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Abstract

Introduction

We assessed the effect of recipient body mass index (BMI) on the outcomes of renal transplantation and the management of obese patients with end-stage renal disease across the UK.

Methods

We analyzed data of 25539 adult renal transplants (2007–2016) from the UK Transplant Registry. Patients were divided in BMI groups [underweight: < 18.5, normal: 18.5–24.9 (reference group), overweight: 25–29.9, class I obese: 30–34.9, class II/III obese: ≥ 35]. We also conducted a national survey of all UK renal transplant centers on the influence of BMI on decisions regarding management of renal transplant candidates.

Results

BMI ≥ 25 was an independent risk factor for delayed graft function and primary non-function (p ≤ 0.001). Underweight (p = 0.001), class I obese (p = 0.017) and class II/III obese recipients (p < 0.001) had poorer graft survival, however, 5- and 10-year graft survival rates were good. Patient survival was shorter for underweight recipients (p < 0.001) and longer for overweight (p = 0.028) and class I obese recipients (p = 0.013). The national survey revealed significant variability among transplant centers in BMI threshold for listing patients on transplant waiting list and limited support with conservative or surgical procedures for weight control.

Conclusions

Obesity alone should not be a barrier for renal transplantation. A national strategy is required to give all patients equal chances in transplantation.

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References

  1. Stommel M, Schoenborn CA (2010) Variations in BMI and prevalence of health risks in diverse racial and ethnic populations. Obesity (Silver Spring) 18:1821–1826

    Article  Google Scholar 

  2. Swinburn B, Vandevijvere S (2016) WHO report on ending childhood obesity echoes earlier recommendations. Public Health Nutr 19:1–2

    Article  Google Scholar 

  3. Potluri K, Hou S (2010) Obesity in kidney transplant recipients and candidates. Am J Kidney Dis 56:143–156

    Article  Google Scholar 

  4. Cannon RM, Jones CM, Hughes MG, Eng M, Marvin MR (2013) The impact of recipient obesity on outcomes after renal transplantation. Ann Surg 257:978–984

    Article  Google Scholar 

  5. Pieloch D, Dombrovskiy V, Osband AJ, Lebowitz J, Laskow DA (2014) Morbid obesity is not an independent predictor of graft failure or patient mortality after kidney transplantation. J Ren Nutr 24:50–57

    Article  Google Scholar 

  6. Gusukuma LW, Harada KM, Baptista AP et al (2014) Outcomes in obese kidney transplant recipients. Transplant Proc 46:3416–3419

    Article  CAS  Google Scholar 

  7. Krishnan N, Higgins R, Short A et al (2015) Kidney transplantation significantly improves patient and graft survival irrespective of BMI: a cohort study. Am J Transplant 15:2378–2386

    Article  CAS  Google Scholar 

  8. Naik AS, Sakhuja A, Cibrik DM, Ojo AO, Samaniego-Picota MD, Lentine KL (2016) The impact of obesity on allograft failure after kidney transplantation: a competing risks analysis. Transplantation 100:1963–1969

    Article  Google Scholar 

  9. Kwan JM, Hajjiri Z, Metwally A, Finn PW, Perkins DL (2016) Effect of the obesity epidemic on kidney transplantation: obesity is independent of diabetes as a risk factor for adverse renal transplant outcomes. PLoS One 11:e0165712

    Article  Google Scholar 

  10. Pruthi R, Tonkin-Crine S, Calestani M et al (2018) Variation in practice patterns for listing patients for renal transplantation in the United Kingdom: a national survey. Transplantation 102:961–968

    Article  Google Scholar 

  11. Tonkin-Crine S, Pruthi R, Taylor DM et al (2018) Assessing consensus between UK renal clinicians on listing for kidney transplantation: a modified Delphi study. Transplant Direct 4:e343

    Article  Google Scholar 

  12. Johnson RJ, Fuggle SV, Mumford L, Bradley JA, Forsythe JL, Rudge CJ (2010) A New UK 2006 National Kidney Allocation Scheme for deceased heart-beating donor kidneys. Transplantation 89:387–394

    Article  Google Scholar 

  13. Lafranca JA, IJermans JN, Betjes MG, Dor FJ (2015) Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis. BMC Med 13:111

    Article  Google Scholar 

  14. Hill CJ, Courtney AE, Cardwell CR et al (2015) Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis. Nephrol Dial Transplant 30:1403–1411

    Article  Google Scholar 

  15. Sood A, Hakim DN, Hakim NS (2016) Consequences of recipient obesity on postoperative outcomes in a renal transplant: a systematic review and meta-analysis. Exp Clin Transplant 14:121–128

    PubMed  Google Scholar 

  16. Nicoletto BB, Fonseca NK, Manfro RC, Gonçalves LF, Leitão CB, Souza GC (2014) Effects of obesity on kidney transplantation outcomes: a systematic review and meta-analysis. Transplantation 98:167–176

    Article  Google Scholar 

  17. Bhaskaran K, Dos-Santos-Silva I, Leon DA, Douglas IJ, Smeeth L (2018) Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK. Lancet Diabetes Endocrinol 6:944–953

    Article  Google Scholar 

  18. Ahmadi SF, Zahmatkesh G, Streja E et al (2014) Body mass index and mortality in kidney transplant recipients: a systematic review and meta-analysis. Am J Nephrol 40:315–324

    Article  Google Scholar 

  19. Pelletier SJ, Maraschio MA, Schaubel DE et al (2003) Survival benefit of kidney and liver transplantation for obese patients on the waiting list. Clin Transpl 2003:77–88

    Google Scholar 

  20. Tsai A, Schumann R (2016) Morbid obesity and perioperative complications. Curr Opin Anaesthesiol 29:103–108

    Article  CAS  Google Scholar 

  21. Baboolal K, McEwan P, Sondhi S, Spiewanowski P, Wechowski J, Wilson K (2008) The cost of renal dialysis in a UK setting—a multicentre study. Nephrol Dial Transplant 23:1982–1989

    Article  Google Scholar 

  22. Treharne C, Liu FX, Arici M, Crowe L, Farooqui U (2014) Peritoneal dialysis and in-centre haemodialysis: a cost-utility analysis from a UK payer perspective. Appl Health Econ Health Policy 12:409–420

    Article  Google Scholar 

  23. Muduma G, Shaw J, Hart WM, Odeyemi A, Odeyemi I (2014) Cost utility analysis of immunosuppressive regimens in adult renal transplant recipients in England and Wales. Patient Prefer Adherence 8:1537–1546

    PubMed  PubMed Central  Google Scholar 

  24. Oberholzer J, Giulianotti P, Danielson KK et al (2013) Minimally invasive robotic kidney transplantation for obese patients previously denied access to transplantation. Am J Transplant 13:721–728

    Article  CAS  Google Scholar 

  25. Lesage J, Gill JS (2017) Management of the obese kidney transplant candidate. Transplant Rev (Orlando) 31:35–41

    Article  Google Scholar 

  26. Miles Maliska C, Jennings W, Mallios A (2015) When arteriovenous fistulas are too deep: options in obese individuals. J Am Coll Surg 221:1067–1072

    Article  Google Scholar 

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Acknowledgements

We would like to thank Ms Lisa Mumford for her valuable assistance in providing the data from NHSBT and her useful comments on their analysis.

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Author notes

  1. Ioannis D. Kostakis and Theodoros Kassimatis contributed equally to this work.

Authors and Affiliations

  1. Department of Transplantation, Guy’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK

    Ioannis D. Kostakis, Theodoros Kassimatis, Valentina Bianchi, Panoraia Paraskeva, Chris Callaghan, Benedict Lyle Phillips, Nikolaos Karydis, Nicos Kessaris, Francis Calder & Ioannis Loukopoulos

  2. School of Population Health and Environmental Studies, King’s College London, London, UK

    Clare Flach

Authors
  1. Ioannis D. Kostakis
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  2. Theodoros Kassimatis
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  3. Valentina Bianchi
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  4. Panoraia Paraskeva
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  5. Clare Flach
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  10. Francis Calder
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  11. Ioannis Loukopoulos
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Contributions

IDK and TK: Literature search, study design, data analysis and interpretation, manuscript preparation and revision; VB: Literature search, data analysis and interpretation, manuscript preparation; PP: Study design, data analysis and interpretation, manuscript preparation; CF: Data analysis and interpretation, manuscript revision; CC, BP, NKa, NK: Literature search, data interpretation, manuscript revision; FC: Literature search, study design, data analysis and interpretation, manuscript revision; IL: Literature search, study design, data analysis and interpretation, manuscript preparation and revision.

Corresponding author

Correspondence to Ioannis D. Kostakis.

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Conflict of interest

All the authors declare that there is no financial support from any organisation for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work and no other relationships or activities that could appear to have influenced the submitted work. All the authors declare that there are no conflicts of interest.

Research involving human participants

Our study conforms to the 2000 Declaration of Helsinki and the 2008 Declaration of Istanbul.

Informed consent

Not applicable. Retrospective study based on the UK Transplant Registry of NHSBT.

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Kostakis, I.D., Kassimatis, T., Bianchi, V. et al. UK renal transplant outcomes in low and high BMI recipients: the need for a national policy. J Nephrol 33, 371–381 (2020). https://doi.org/10.1007/s40620-019-00654-7

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  • DOI: https://doi.org/10.1007/s40620-019-00654-7

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