Kidney transplantation in obese patients

Table 1 Post-transplant complications among obese vs nonobese patients

Ref.	Groups		Complication	Outcome differences
	Obese	Nonobese		Obese	Nonobese
Singh et al[9]	BMI > 30 (34.1 ± 3.68)	BMI ≤ 30 (23.6 ± 3.18)	OR time (min)	155 ± 59	119 ± 44
1999-2002	n = 33	n = 35	LOS (d)	13.7 ± 10	9.48 ± 4.8 (P = 0.029)
	Age 48 ± 11.1	Age 43.5 ± 13.5	DGF	33.3%	17.1% (P = 0.12)
			Wound infection	18.2%	0 (P = 0.01)
			Lymphocele	18.2%	2.94% (P = 0.02)
			Perinephric HTMA	12.1%	0 (P = 0.05)
			Incisional hernia	6%	3.7% (P = 0.68)
			NODAT	9%	3.7% (P = 0.41)
Cacciola et al[10]	BMI ≥ 35	BMI 30-34.9	1/5 yr graft surv	75%/63%	98.9/94.5 (P = NS)
1993-2003	n = 24 (Group B)	n = 90 (Group A)	1/5 yr pt surv	87.5/79.2	98.9/95.6 (P = NS)
	Age 45 (20-61)	Age 45 (25-70)	DGF	16.5%	22% (P = NS)
Mehta et al[11]	BMI ≥ 30	BMI < 30	1 yr graft surv	94%	97% (P = 0.51)
1999-2002	n = 16	n = 37	1 yr patient surv	100%	100%
Living donor	Age 50 ± 16	Age 43 ± 16	Acute rejection	19%	8% (P = 0.35)
			Wound Cxn	19%	13.5% (P = 0.68)
			Other Cxns	25%	11% (P = 0.22)
			DGF	19%	2.7% (P = 0.077)
			LOS (d)	8.4 ± 7	6.4 ± 5 (P = 0.68)
Marks et al[12]	BMI ≥ 35 (35-56)	BMI ≤ 25 (17-28)	1/3 yr graft surv	LD 100/100 DD 92/75	LD 95/91 DD 94/90
1995-2000	n = 23	(n = 224)	1/3 yr pt surv	LD 100/100 DD 92/83	LD 97/95 DD 96/94
	Age DD: 44 ± 14	Age DD: 48.5 ± 13	LOS (d)	LD 10.2 ± 8.0 DD 12.9 ± 9.0	LD 6.0 ± 4.1 DD 7.8 ± 3.0
	Age LD: 46 ± 1	Age LD: 43 ± 13	Readmission 6 mo	LD 82% DD 92%	LD 20% DD 49%
			Mult admits 1st 6 mo	LD 44% DD 50%	LD 21% DD 18%
			Major wound infxn	LD 44% DD 33%	LD 2% DD 4%
Grosso et al[13]	BMI > 30	BMI ≤ 30	Graft loss 1 yr/3 yr	6.4/42.9	5.3/7.7
2000-2010	n = 64	n = 312	Pt death 1 yr/3 yr	7.6/46.2	3.5/11.8
	Age 49.1 ± 12.9	Age 49.8 ± 11.1	DGF	31.3%	20.5% (P = 0.253)
		(BMI 25-30)
		Age 44.9 ± 13.7
		(BMI < 25)
Schwarznau et al[14]	BMI > 25 (28.1 ± 2.6)	BMI < 25 (21.4 ± 2.0)	1 yr graft survival	94.6%	76% (P < 0.001)
2000-2004	n = 25	n = 56
Living donor	Age 49.2 ± 10.9	Age 42.8 ± 13.6
Bardonnaud et al[15]	BMI ≥ 30 (35.1 ± 4.35)	BMI < 30 (22.9 ± 3.17)	DGF	38% ± 0.5%	14% ± 0.34% (P = 0.004)
2004-2008	n = 21	n = 179	Lymphocele	14.3%	4.5 (P = 0.062)
	Age 53.3 ± 11.19	Age 46.7 ± 15.05	Wound dehiscence	4.8% ± 0.22%	2.2% ± 0.15% (P = 0.485)
			(pretransplant DM)	29%	6% (P < 0.0001)
			LOS (d)	24.9	15.6 (P = 0.008)
Gusukuma et al[16]	BMI ≥ 35 (36.8 ± 1.7)	BMI < 30 (22.6 ± 3.3)	1 yr graft/pt surv	93.6%/95.6%	97.7%/98.1% (P = NS)
1998-2008	n = 47	n = 2822	5 yr graft/pt surv	84.0%/89.1%	88.8%/90.5% (P = NS)
	Age 46.5 ± 10.9	Age 40.7 ± 12.1	DGF	16.7% ± 19.3%	13.5% ± 16.2% (P = NS)
			Wound dehiscence	19.1%	1.9% (P < 0.001)
			Lymphocele	6.4%	2.6% (P = 0.054)
			NODAT	36%	16.2% (P < 0.001)
			LOS (d)	15.9 ± 16.7	11.3 ± 11.4 (P < 0.001)
Furriel et al[17]	BMI ≥ 30 (32.44 ± 1.86)	BMI < 25 (22.03 ± 1.79)	DGF	26.9%	16.9%
1984-2008	n = 26	n = 295	Lymphocele	7.7%	1.4%
	Age 46.08 ± 12.75	Age 41.51 ± 13.23	Wound dehiscence	11.5%	0.7%
Behzadi et al[18]	BMI ≥ 30 (none > 35)	BMI < 30	RAS	17.6%	2.8% (P < 001)
2006-2008	n = 34	n = 146	Hematoma	47.9%	17.6% (P = 0.009)
Age 39.8			Wound Cxn	64.7%	9.6% (P < 0.001)
			Renal vein thromb	2%	0% (P < 0.05)
			DGF	8.8%	6.80%
			Lymphocele	2.9%	1.40%
Johnson et al[19]	BMI ≥ 30 (32.0 ± 0.3)	BMI < 30 (23.4 ± 0.2)	Wound breakdown	14%	4% (P < 0.01)
1994-2000	n = 59	n = 434	Wound dehiscence	3%	0% (P < 0.01)
			Wound Infection	15%	8% (P = 0.11)

BMI: Body mass index; Cxn(s): Complication(s); DD: Deceased donor; DGF: Delayed graft function; DM: Diabetes mellitus; HTMA: Hematoma; LOS: Length of stay; LD: Living donor; NODAT: New onset diabetes after transplant; OR time: Operating time; pt: Patient; RR: Relative Risk; Surv: Survival; NS: Not significant.