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Where to Draw the Line in Surgical Obesity for Renal Transplant Recipients: An Outcome Analysis Based on Body Mass Index.

OBJECTIVES
Renal transplant is the criterion standard treatment for patients with end-stage renal disease. Because obesity rates are increasing in the global population, international standards on renal transplant in obese patients remain a gray area. The aim of this study was to determine whether renal transplant remains the treatment of choice in an obese patient with end-stage renal disease.


MATERIALS AND METHODS
We performed a retrospective analysis on all patients who underwent renal transplant in our transplant unit between January 2008 and December 2013. Patients were divided into 3 cohorts based on body mass index (cohort A was < 25 kg/m2, cohort B was 25-29.99 kg/m2, and cohort C was ≥ 30 kg/m2). Postoperative complications within 90 days after transplant were assessed using one-way analysis of variance and chi-square distribution. Patient and graft survival rates over 3 years were assessed with Kaplan-Meier analyses.


RESULTS
Of 610 total patients, 92 patients (15%) were classified as "obese" (≥ 30 kg/m2) in cohort C, with 294 patients in cohort A and 224 patients in cohort B (24 patients were excluded). Regarding short-term complications during the 90-day posttransplant period, obese individuals were at increased risk of a higher number of complications (P = .039 for cohort A vs cohort C). Lymphocele in particular was associated with obesity (P = .004); fortunately, this condition had no direct impact on the graft itself and was relatively easy to monitor and treat. The long-term outlook (3 years) appeared positive, with both graft survival (92% in cohort A, 91% in cohort B, and 94% in cohort C) and patient survival (97% in cohort A, 99% in cohort B, and 97% in cohort C) being independent of patient obesity.


CONCLUSIONS
Increased body mass index up to 37.5 kg/m2 was not associated with increased risk of serious postoperative morbidity or mortality after renal transplant. Surgery should be considered as the criterion standard treatment for obese patients with end-stage renal disease if they are otherwise medically fit with few or well-controlled comorbidities.