Evaluación del impacto de la obesidad en los resultados del trasplante renal / Does obesity really affect renal transplantation outcomes?

Introducción El trasplante renal es el tratamiento de elección para pacientes con enfermedad renal crónica (ERC) estadio 5. Alrededor de 60% de los pacientes con ERC presentan sobrepeso u obesidad en el momento del trasplante de riñón, y la obesidad postrasplante se da en 50% de los pacientes, con un aumento de peso de 10% en el primer año y un alto riesgo de mortalidad cardiovascular. La obesidad se asocia a un mayor riesgo de retraso de la función del injerto (RFI), rechazo agudo, complicaciones quirúrgicas, pérdida del injerto y mortalidad. El objetivo de este estudio es evaluar la evolución clínica de los pacientes obesos y con sobrepeso receptores de un trasplante renal, en términos de las complicaciones a corto y largo plazo asociadas a un mayor índice de masa corporal (IMC). Material y métodos Se realizó un estudio descriptivo, observacional y transversal con 104 pacientes sometidos a trasplante de riñón o páncreas-riñón entre marzo de 2017 y diciembre de 2020, con seguimiento hasta abril de 2021. Para el análisis comparativo, los pacientes se agruparon según el IMC. Resultados La edad media fue de 56,65 años, 60,6% varones y 39,4% mujeres. Los pacientes con sobrepeso experimentaron cirugías más prolongadas, más dehiscencia de la herida quirúrgica, RFI, hernias, proteinuria y un requerimiento mayor de biopsias renales. Por otro lado, los pacientes obesos presentaron más RFI, mayor número de biopsias renales requeridas, proteinuria, desarrollo de diabetes mellitus y fibrilación auricular, y necesitaron estancias hospitalarias más prolongadas. Conclusiones A pesar de la alta prevalencia de comorbilidad en la población con sobrepeso y/u obesidad, no se observó un empeoramiento en la supervivencia del paciente y/o del injerto. Sin embargo, es necesario un seguimiento más prolongado. (AU)

Introduction Kidney transplantation is the treatment of choice for patients with stage 5 chronic kidney disease (CKD). About 60% of CKD patients are overweight or obese at the time of kidney transplantation, and post-transplant obesity occurs in 50% of patients, with a weight gain of 10% in the first year and high risk of cardiovascular mortality. Obesity is associated with an increased risk of delayed graft function (DGF), acute rejection, surgical complications, graft loss and mortality. The aim of this study is to assess the clinical evolution of obese and overweight patients that have received a kidney transplant, based on short- and long-term complications associated with a higher BMI. Material and methods A descriptive, observational, cross-sectional study was conducted with 104 kidney or pancreas-kidney transplant patients between March 2017 and December 2020, with a follow-up until April 2021. For comparative analysis, patients were grouped according to BMI. Results Mean age was of 56.65 years, 60.6% male and 39.4% female. Overweight patients experienced prolonged surgeries, more surgical wound dehiscence, delayed graft function, hernias, proteinuria and more indications for renal biopsies. Additionally, obese patients displayed more DGF, indications for renal biopsies, proteinuria, development of diabetes mellitus, atrial fibrillation and needed prolonged hospital stays. Conclusions Despite a high prevalence of comorbidity in the overweight and/or obese population, we found no reduction in patient and/or graft survival. However, longer follow-up is needed. (AU)

Does obesity really affect renal transplantation outcomes?

INTRODUCTION: Kidney transplantation is the treatment of choice for patients with stage 5 chronic kidney disease (CKD). About 60% of CKD patients are overweight or obese at the time of kidney transplantation, and post-transplant obesity occurs in 50% of patients, with a weight gain of 10% in the first year and high risk of cardiovascular mortality. Obesity is associated with an increased risk of delayed graft function (DGF), acute rejection, surgical complications, graft loss and mortality. The aim of this study is to assess the clinical evolution of obese and overweight patients that have received a kidney transplant, based on short- and long-term complications associated with a higher BMI. MATERIAL AND METHODS: A descriptive, observational, cross-sectional study was conducted with 104 kidney or pancreas-kidney transplant patients between March 2017 and December 2020, with a follow-up until April 2021. For comparative analysis, patients were grouped according to BMI. RESULTS: Mean age was of 56.65 years, 60.6% male and 39.4 % female. Overweight patients experienced prolonged surgeries, more surgical wound dehiscence, delayed graft function, hernias, proteinuria and more indications for renal biopsies. Additionally, obese patients displayed more DGF, indications for renal biopsies, proteinuria, development of diabetes mellitus, atrial fibrillation and needed prolonged hospital stays. CONCLUSIONS: Despite a high prevalence of comorbidity in the overweight and/or obese population, we found no reduction in patient and/or graft survival. However, longer follow-up is needed.