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| Year : 2011 | Volume
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| Issue : 4 | Page : 799-801 |
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| Effect of post-transplant weight at one year on renal allograft function |
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MR Gumber1, SH Jain1, VB Kute1, MS Gireesh1, PR Shah1, HV Patel1, KR Goplani1, AV Vanikar2, HL Trivedi1
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
Click here for correspondence address and email
| Date of Web Publication | 9-Jul-2011 |
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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 2021 Feb 26];22:799-801. Available from: https://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.
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 | |  |
| 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. 
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| 2. | Johnson CP, Gallagher-Lepak S, Zhu YR, et al. Factors influencing weight gain after renal transplantation. Transplantation 1993;56:822-7.
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| 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.
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| 4. | Nazemian F, Naghibi M. Weight-gain-related factors in renal transplantation. Exp Clin Transplant 2005;3:329-32.
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| 5. | Praga M. Obesity-a neglected culprit in renal disease. Nephrol Dial Transplant 2002;17: 1157-9.
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| 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.
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| 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 .
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| 8. | Thoma B, Grover VK, Shoker A. Prevalence of weight gain in patients with better renal transplant function. Clin Nephrol 2006;65:408-14.
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| 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.
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| 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.
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| 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.
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| 12. | Merion RM, Twork AM, Rosenberg L, et al. Obesity and renal transplantation. Surg Gynecol Obstet 1991;172:367-76.
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| 13. | Johnson DW, Isbel NM, Brown AM, et al. The effect of obesity on renal transplant outcomes. Transplantation 2002;74:675-81.
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| 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.
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| 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
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| 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.
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| 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.
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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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