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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2011  |  Volume : 22  |  Issue : 4  |  Page : 799-801
Effect of post-transplant weight at one year on renal allograft function


1 Department of Nephrology and Clinical Transplantation, Transfusion Services and Immunohematology, Dr. H. L. Trivedi Institute of Transplantation Sciences (ITS) -Smt Gulabben Rasiklal Doshi and Smt Kamlaben Mafatlal Mehta Institute of Kidney Diseases & Research Centre (IKDRC), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India
2 Department of Pathology, Laboratory Medicine, Transfusion Services and Immunohematology, Dr. H. L. Trivedi Institute of Transplantation Sciences (ITS) -Smt Gulabben Rasiklal Doshi and Smt Kamlaben Mafatlal Mehta Institute of Kidney Diseases & Research Centre (IKDRC), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat, India

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Date of Web Publication9-Jul-2011
 

How to cite this article:
Gumber M R, Jain S H, Kute V B, Gireesh M S, Shah P R, Patel H V, Goplani K R, Vanikar A V, Trivedi H L. Effect of post-transplant weight at one year on renal allograft function. Saudi J Kidney Dis Transpl 2011;22:799-801

How to cite this URL:
Gumber M R, Jain S H, Kute V B, Gireesh M S, Shah P R, Patel H V, Goplani K R, Vanikar A V, Trivedi H L. Effect of post-transplant weight at one year on renal allograft function. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Aug 23];22:799-801. Available from: http://www.sjkdt.org/text.asp?2011/22/4/799/82706
To the Editor,

Obesity has assumed epidemic proportions worldwide and is more prevalent in the Indian subcontinent. [1] Weight gain after transplantation is common, ranging from 10 to 20% during the first year. [2],[3] The causes of obesity in this population include feeling of well-being, disappearance of dietary restrictions, decreased physical activities, and increased appetite (probably due to steroid medication) resulting in an increased nutrient intake. [4] According to WHO guidelines, a body mass index (BMI) over 25 kg/m 2 is defined as overweight and a BMI of over 30 kg/m 2 as obese. Obesity is the hallmark of metabolic syndrome (MS), but it also includes insulin resistance, hyperinsulinemia and dyslipidemia. In humans, obesity is associated with focal and segmental glomerulosclerosis. [5] More recently, both obesity and MS have been suggested to participate in the progression of renal disease [6] as well as chronic allograft nephopathy. [7]

We retrospectively studied 110 patients for the relationship of the weight at one year post-transplant (expressed as percentage gain/loss above the weight at 15 days post-transplant) with graft function. The patients who expired or lost their grafts within a year of transplant were excluded from the study. The patients were divided into the following three groups: weight loss (group 1), weight increase 0-10% (group 2), and weight increase >10% (group 3) [Table 1]. Description of weight change was presented as percentage of original body weight at baseline.
Table 1. Demographics and variables in subgroups.

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Correlation was sought by using Pearson's correlation coefficient. The study included 100 males and 10 females with mean age of 34 ± 11.6 years. The average weight gain at the end of first post-transplant year was 18.6 ± 16.4%. A positive correlation was observed between the weight gain and serum creatinine (SCr). The correlation coefficients of weight gain with that of post-transplant creatinine at the end of first, second, and third years were 0.18, 0.18, and 0.26, with a P value of 0.062, 0.073, and 0.009, respectively. Graft loss was 11.1%, 8%, and 7.69%, whereas mortality was 4.16%, 4%, and 15.3% in patients with >10% weight gain, 0-10% weight gain, and weight loss, respectively. Weight gain >10% at one year post-transplant was associated with poor graft function.

In our study, the average percent weight gain at the end of first post-transplant year was 18.6 ± 16.4%. Studies evaluating this issue reported similar results. Johnson et al [2] observed a weight gain of 10.9% during the first year and 15.3% at 5 years post-transplant (PTx). Thoma et al [8] noted an increase of 7.7% and 10.9% at 1 and 5 years, respectively.

In our study, 67.27% patients had more than 10% weight gain at the end of first year. This was found to be much higher than that found in studies by Nazemian et al [3] and Baum et al, [9] where 27.1% and 39% of the recipients were obese at 1 year after transplantation, respectively. This aspect is important because obesity and overweight are important risk factors for cardiovascular disease, which is the main cause of death in this population. [10]

Studies previously evaluating the impact of obesity on graft survival had conflicting results. While some investigators found no influence for BMI on transplant outcomes, [11],[12],[13],[14],[15] others reported a significant decrease in longterm graft survival in obese patients. [12],[13],[16],[17] In these studies, the impact of BMI on graft survival was only evaluated in severe obesity. De Vries et al [7] suggested that MS was associated with impaired renal allograft function beyond 1 year PTx. In our study, there was a positive and significant association between weight gain and SCr after renal transplantation. Also, there was a trend toward higher graft loss in the group with >10% weight gain.

 
   References Top

1.Zargar AH, Masoodi SR, Laway BA, et al. Prevalence of obesity in adults-an epidemiological study from Kashmir Valley of Indian Subcontinent. J Assoc Physicians India 2000; 48:1170-4.  Back to cited text no. 1
    
2.Johnson CP, Gallagher-Lepak S, Zhu YR, et al. Factors influencing weight gain after renal transplantation. Transplantation 1993;56:822-7.  Back to cited text no. 2
    
3.el-Agroudy AE, Wafa EW, Gheith OE, Shehab el-Dein AB, Ghoneim MA. Weight gain after renal transplantation is a risk factor for patient and graft outcome. Transplantation 2004;77: 1381-5.  Back to cited text no. 3
    
4.Nazemian F, Naghibi M. Weight-gain-related factors in renal transplantation. Exp Clin Transplant 2005;3:329-32.  Back to cited text no. 4
    
5.Praga M. Obesity-a neglected culprit in renal disease. Nephrol Dial Transplant 2002;17: 1157-9.  Back to cited text no. 5
    
6.El-Atat FA, Stas SN, McFarlane SI, Sowers JR. The relationship between hyperinsulinemia, hypertension, and progressive renal disease. J Am Soc Nephrol 2004;15:2816-2.  Back to cited text no. 6
    
7.de Vries AP, Bakker SJ, van Son WJ, et al. Metabolic syndrome is associated with impaired long-term renal allograft function; not all component criteria contribute equally. Am J Transplant 2004;4:1675-83 .   Back to cited text no. 7
    
8.Thoma B, Grover VK, Shoker A. Prevalence of weight gain in patients with better renal transplant function. Clin Nephrol 2006;65:408-14.  Back to cited text no. 8
    
9.Baum CL, Thielke K, Westin E, Kogan E, Cicalese L, Benedetti E. Predictors of weight gain and cardiovascular risk in a cohort of racially diverse kidney transplant recipients. Nutrition 2002;18:139-46.  Back to cited text no. 9
    
10.Fernández-Fresnedo G, Rodrigo E, Valero R, et al. Traditional cardiovascular risk factors as clinical markers after kidney transplantation. Transplant Rev 2006;20:88.  Back to cited text no. 10
    
11.National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III): final report. Circulation 2002;106:3143.  Back to cited text no. 11
    
12.Merion RM, Twork AM, Rosenberg L, et al. Obesity and renal transplantation. Surg Gynecol Obstet 1991;172:367-76.  Back to cited text no. 12
    
13.Johnson DW, Isbel NM, Brown AM, et al. The effect of obesity on renal transplant outcomes. Transplantation 2002;74:675-81.  Back to cited text no. 13
    
14.Meier-Kriesche HU, Arndorfer JA, Kaplan B. The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation 2002;73:70-4.  Back to cited text no. 14
    
15.Howard RJ, Thai VB, Patton PR, et al. Obesity does not portend a bad outcome for kidney transplant recipients. Transplantation 2002;73: 53-5  Back to cited text no. 15
    
16.Drafts HH, Anjum MR, Wynn JJ, Mulloy LL, Bowley JN, Humphries AL. The impact of pretransplant obesity on renal transplant outcomes. Clin Transplant 1997;11:493-6.  Back to cited text no. 16
    
17.Yamamoto S, Hanley E, Hahn AB, et al. The impact of obesity in renal transplantation: an analysis of paired cadaver kidneys. Clin Transplant 2002;16:252-6.  Back to cited text no. 17
    

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Correspondence Address:
M R Gumber
Department of Nephrology and Clinical Transplantation, Transfusion Services and Immunohematology, Dr. H. L. Trivedi Institute of Transplantation Sciences (ITS) -Smt Gulabben Rasiklal Doshi and Smt Kamlaben Mafatlal Mehta Institute of Kidney Diseases & Research Centre (IKDRC), Civil Hospital Campus, Asarwa, Ahmedabad, Gujarat
India
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PMID: 21743234

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