Body Mass Index as a Contraindication for Kidney Transplantation

Background: Chronic kidney disease (CKD) is a rising health concern worldwide, especially in Indonesia. The treatment of choice for end-stage renal disease is Kidney Transplantation.1 Numerous studies showed that prolonged total ischemic ischemic time may cause hypoxia of the graft tissue and increased risk of ischemia and reperfusion injury (IRI) and delayed graft function (DGF).2 Body mass index of kidney transplant recipients may cause prolonged duration of the procedure, as well as prolonged total ischemic time. This study aimed to determine the correlation between prolonged total ischemic time with body mass index. Method: This was an observational and cross-sectional analysis at Kariadi General Hospital Semarang involving patients who underwent kidney transplantation from January 2016 to December 2019. The total ischemic time was recorded intraoperatively. The Body Mass Index data were provided by medical records. The program used to statistically analyze the data was SPSS 23.0, and Spearman was used for hypothesis testing. Result: This study included 25 kidney transplant recipients. The mean total ischemic time was 43,27 ± 6,63 minutes. There was a significant positive correlation between prolonged ischemic time and body mass index (r= 0,506 ; p= 0,010). Conclusion: Prolonged total ischemic time was positively correlated with increased body mass index and these results are statistically significant.

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Body mass index, weight-adjusted immunosuppression and the risk of acute rejection and infection after kidney transplantation: a cohort study

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz095 ◽

2019 ◽

Vol 34 (12) ◽

pp. 2132-2143 ◽

Cited By ~ 4

Author(s):

Katerina Flabouris ◽

Steven Chadban ◽

Maleeka Ladhani ◽

Matthew Cervelli ◽

Philip Clayton

Keyword(s):

Body Mass Index ◽

Kidney Transplantation ◽

Acute Rejection ◽

Body Mass ◽

Cox Models ◽

Fatal Infection ◽

Adult Kidney ◽

Transplant Registry ◽

Index Weight ◽

Time Varying Covariates

Abstract Background Body mass index (BMI) is associated with patient outcomes after kidney transplantation. We hypothesized that immunosuppression (IS) dosing is a contributing factor. Methods Using Australia and New Zealand Dialysis and Transplant registry data, we included all adult kidney-only transplant recipients over 2000–14 treated with prednisolone, mycophenolate and tacrolimus/cyclosporin (n = 7919). The exposure was BMI and the outcomes were time to: (i) acute rejection, (ii) fatal infection, (iii) cancer and (iv) graft; and (v) patient survival. We modelled BMI and IS dosing (in quartiles) as time-varying covariates in extended Cox models. Results Compared with a BMI of 25 kg/m2, a BMI of 35 was associated with acute rejection after adjusting for demographics and comorbidities [adjusted hazard ratio (aHR) = 1.29, 95% confidence interval (CI) 1.12–1.49]. This association virtually disappeared after correcting for IS (aHR = 1.09, 95% CI 0.93–1.29). A BMI of 35 was non-significantly associated with fewer fatal infections (aHR = 0.91, 95% CI 0.66–1.25), but this reversed after adjusting for IS (aHR = 1.54, 95% CI 1.03–2.28). Results for cancer were not significantly altered after adjusting for IS. Results for lower BMI were similarly not significantly altered though generally associated with worse outcomes. Conclusions Our findings show that the associations between high BMI, acute rejection and fatal infection after kidney transplantation were significantly altered after correcting for IS suggesting that relative under-dosing of obese patients may partially explain these associations.

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Heart Failure Risk before and after Kidney Transplantation: Importance of Body Mass Index

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2008.06.338 ◽

2008 ◽

Vol 14 (6) ◽

pp. S83

Author(s):

Krista L. Lentine ◽

Huiling Xiao ◽

Mark A. Schnitzler ◽

Paul J. Hauptman

Keyword(s):

Heart Failure ◽

Body Mass Index ◽

Kidney Transplantation ◽

Body Mass ◽

Failure Risk ◽

Before And After

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Weighing the waitlist: Weight changes and access to kidney transplantation among obese candidates

PLoS ONE ◽

10.1371/journal.pone.0242784 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242784

Author(s):

Elaine Ku ◽

Adrian M. Whelan ◽

Charles E. McCulloch ◽

Brian Lee ◽

Claus U. Niemann ◽

...

Keyword(s):

Body Mass Index ◽

Weight Loss ◽

Kidney Transplantation ◽

Weight Gain ◽

Body Mass ◽

Deceased Donor ◽

Weight Changes ◽

Living Donor Transplantation ◽

Race Ethnicity ◽

End Stage

High body mass index is a known barrier to access to kidney transplantation in patients with end-stage kidney disease. The extent to which weight and weight changes affect access to transplantation among obese candidates differentially by race/ethnicity has received little attention. We included 10 221 obese patients waitlisted for kidney transplantation prior to end-stage kidney disease onset between 1995–2015. We used multinomial logistic regression models to examine the association between race/ethnicity and annualized change in body mass index (defined as stable [-2 to 2 kg/m2/year], loss [>2 kg/m2/year] or gain [>2 kg/m2/year]). We then used Fine-Gray models to examine the association between weight changes and access to living or deceased donor transplantation by race/ethnicity, accounting for the competing risk of death. Overall, 29% of the cohort lost weight and 7% gained weight; 46% received a transplant. Non-Hispanic blacks had a 24% (95% CI 1.12–1.38) higher odds of weight loss and 22% lower odds of weight gain (95% CI 0.64–0.95) compared with non-Hispanic whites. Hispanics did not differ from whites in their odds of weight loss or weight gain. Overall, weight gain was associated with lower access to transplantation (HR 0.88 [95% CI 0.79–0.99]) compared with maintenance of stable weight, but weight loss was not associated with better access to transplantation (HR 0.96 [95% CI 0.90–1.02]), although this relation differed by baseline body mass index and for recipients of living versus deceased donor organs. For example, weight loss was associated with improved access to living donor transplantation (HR 1.24 [95% CI 1.07–1.44]) in whites but not in blacks or Hispanics. In a cohort of obese patients waitlisted before dialysis, blacks were more likely to lose weight and less likely to gain weight compared with whites. Weight loss was only associated with improved access to living donor transplantation among whites. Further studies are needed to understand the reasons for the observed associations.

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