Implications of excess weight on kidney donation: Long-term consequences of donor nephrectomy in obese donors.

Autor: Serrano OK; Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis. Electronic address: serra061@umn.edu., Sengupta B; Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis., Bangdiwala A; Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis., Vock DM; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis., Dunn TB; Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis., Finger EB; Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis., Pruett TL; Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis., Matas AJ; Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis., Kandaswamy R; Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2018 Nov; Vol. 164 (5), pp. 1071-1076. Date of Electronic Publication: 2018 Aug 24.
DOI: 10.1016/j.surg.2018.07.015
Abstrakt: Background: An elevated body mass index (>30 kg/m 2 ) has been a relative contraindication for living kidney donation; however, such donors have become more common. Given the association between obesity and development of diabetes, hypertension, and end-stage renal disease, there is concern about the long-term health of obese donors.
Methods: Donor and recipient demographics, intraoperative parameters, complications, and short- and long-term outcomes were compared between contemporaneous donors-obese donors (body mass index ≥30 kg/m 2 ) versus nonobese donors (body mass index <30 kg/m 2 ).
Results: Between the years 1975 and 2014, we performed 3,752 donor nephrectomies; 656 (17.5%) were obese donors. On univariate analysis, obese donors were more likely to be older (P < .01) and African American (P < .01) and were less likely to be a smoker at the time of donation (P = .01). Estimated glomerular filtration rate at donation was higher in obese donors (115 ± 36 mL/min/1.73m 2 ) versus nonobese donors (97 ± 22 mL/min/1.73m 2 ; P < .001). There was no difference between groups in intraoperative and postoperative complications; but intraoperative time was longer for obese donors (adjusted P < .001). Adjusted postoperative length of stay (LOS) was longer (adjusted P = .01), but after adjustment for donation year, incision type, age, sex, and race, there were no differences in short-term (<30 days) and long-term (>30 days) readmissions. Estimated glomerular filtration rate and rates of end-stage renal disease were not significantly different between donor groups >20 years after donation (P = .71). However, long-term development of diabetes mellitus (adjusted hazard ratio (HR) 3.14; P < .001) and hypertension (adjusted hazard ratio (HR) 1.75; P < .001) was greater among obese donors and both occurred earlier (diabetes mellitus: 12 vs 18 years postnephrectomy; hypertension: 11 vs 15 years).
Conclusion: Obese donors develop diabetes mellitus and hypertension more frequently and earlier than nonobese donors after donation, raising concerns about increased rates of end-stage renal disease.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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