Faculty Collaboration Database

Implications of excess weight on kidney donation: Long-term consequences of donor nephrectomy in obese donors. Surgery 2018 Nov;164(5):1071-1076

Date

08/29/2018

Pubmed ID

30149934

DOI

10.1016/j.surg.2018.07.015

Scopus ID

2-s2.0-85052128361 (requires institutional sign-in at Scopus site)   29 Citations

Abstract

BACKGROUND: An elevated body mass index (>30 kg/m²) 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/m²) versus nonobese donors (body mass index <30 kg/m²).

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/1.73m²) versus nonobese donors (97 ± 22 mL/min/1.73m²; 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.

Author List

Serrano OK, Sengupta B, Bangdiwala A, Vock DM, Dunn TB, Finger EB, Pruett TL, Matas AJ, Kandaswamy R

Author

Ty Blink Dunn MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Age Factors
Body Mass Index
Diabetes Mellitus
Female
Glomerular Filtration Rate
Humans
Hypertension
Kidney
Kidney Transplantation
Living Donors
Male
Middle Aged
Nephrectomy
Obesity
Postoperative Complications
Prospective Studies
Retrospective Studies
Time Factors
Tissue and Organ Harvesting
Transplant Donor Site