Impact of Obesity on Renal Graft Function-Analysis of Kidney Grafts From the Same Donor.

BACKGROUND: The epidemic of obesity has led to dilemmas facing all nephrologists who care for patients with chronic kidney disease and who must make decisions regarding whether or not the patient can undergo transplantation. The aim of the study was to assess the outcome of transplantation among obese compared to nonobese recipients. To minimize donor variability and bias, paired kidney analysis was applied. MATERIALS AND METHODS: Patients with a body mass index >30 who received transplants in our unit between January 2000 and December 2010 were selected. For the analysis, only obese transplant recipients (OTR) and their kidney donor pairs with a body mass index <30 (nonobese transplant recipients [NOTR]) were selected. A total of 37 pairs of patients were evaluated in terms of the graft function, patient and graft survival, and number of complications. RESULTS: Groups did not differ with respect to sex and comorbidities. OTR were older than NOTR (53.1 vs 46.02 years old, P < .05). One-year patient and graft survivals were similar (100% vs 97.29% and 100% vs 94.59% in OTR and NOTR, respectively). There were no significant differences between OTR and NOTR with respect to incidence of acute rejection (29.7% vs 18.9%), delayed graft function (35.13% vs 29.72%), and mean serum creatinine and estimated glomerular filtration rate (four-variable Modification of Diet in Renal Disease formula) assessed at discharge and after 3, 6, and 12 months, respectively. OTR had a significantly longer hospitalization time (25.56 vs 20.66 days; P < .05), and more often experienced wound breakdown (32.43% vs 8.1%; P < .05) and new-onset diabetes after transplantation (57.14% vs 6.25%; P < .05). CONCLUSIONS: Obesity did not negatively influence patient and graft survival. Transplantation in obese patients should not be postponed.

Tissue Doppler Imaging and Intima-Media Thickness as Noninvasive Methods of Cardiovascular Risk Stratification in Patients After Kidney Transplantation.

BACKGROUND: Cardiovascular complications, including coronary artery disease and chronic heart failure, are the leading causes of death in patients with chronic kidney disease. New echocardiographic techniques, such as tissue Doppler imaging (TDI) with strain and strain rate, are noninvasive, easy-to-perform methods of the estimation of left ventricular (LV) systolic and diastolic function. The aim of the study was to analyze the utility of new noninvasive methods of cardiovascular risk stratification in patients after kidney transplantation. METHODS: We included 43 consecutive kidney transplant (KT) recipients, with 30 healthy subjects constituting the control group in the study. We evaluated LV morphology and LV systolic and diastolic function by means of echocardiography with TDI and intima-media thickness by ultrasonography of the carotid arteries. RESULTS: LV mass index was significantly higher in transplanted patients, and both mitral inflow E/A and Em/Am ratios from pulsed myocardial imaging were significantly lower in the KT group as compared with the control group. The systolic wave of TDI at the basal segments was much lower in KT patients than in the control patients (P < .05). The mean value of strain rate was reduced in KT recipients as compared with the control patients. IMT was significantly higher in KT recipients. CONCLUSIONS: Echocardiography with TDI provided more accurate information about systolic and diastolic LV function. KT recipients showed significant alterations in LV longitudinal myocardial function parameters estimated by strain and strain rate. Strain and strain rate are noninvasive methods, easy to repeat, and valuable for detecting myocardial LV dysfunction in asymptomatic KT recipients.