Effects of Obesity on Kidney Transplantation Outcomes: A Systematic Review and Meta-Analysis
Abstract
BACKGROUND: The effects of obesity on outcomes reported after kidney transplantation have been controversial. The purpose of this systematic review and meta-analysis was to elucidate this issue. METHODS: MEDLINE, EMBASE, Cochrane Library, and gray literature were searched up to August 6, 2013. Studies that compared obese and nonobese patients who underwent kidney transplantation and evaluated one of these outcomes-delayed graft function (DGF), acute rejection, graft or patient survival at 1 or 5 years after transplantation, or death by cardiovascular disease (CVD)-were included. Two independent reviewers extracted the data and assessed the quality of the studies. RESULTS: From 1,973 articles retrieved, 21 studies (9,296 patients) were included. Obesity was associated with DGF (relative risk, 1.41; 95% confidence interval, 1.26-1.57; I=8%; Pheterogeneity=0.36), but not with acute rejection. Graft loss and death were associated with obesity only in the analysis of studies that evaluated patients who received a kidney graft before year 2000. No association of obesity with graft loss and death was found in the analysis of studies that evaluated patients who received a kidney graft after year 2000. Death by CVD was associated with obesity (relative risk, 2.07; 95% confidence interval, 1.17-3.64; I=0%; Pheterogeneity=0.59); however, most studies included in this analysis evaluated patients who received a kidney graft after year 2000. CONCLUSION: In conclusion, obese patients have increased risk for DGF. In the past years, obesity was a risk factor for graft loss, death by CVD, and all-cause mortality. However, for the obese transplanted patient today, the graft and patient survival is the same as that of the nonobese patient.
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Obesity after kidney transplantation is associated with higher rates of early complications, including delayed graft functioning and surgical complications, and higher rates of adverse long-term complications such as cardiovascular diseases.
“They reported higher rates of complications early after transplantation, including delayed graft functioning and surgical complications as well as a higher rate of adverse long-term complications such as cardiovascular diseases.”
Overweight and obesity after kidney transplantation are associated with adverse outcomes.
“Overweight and obesity after KTx are strongly associated with adverse outcomes.”
Findings on the association between obesity and graft loss and morbidity after kidney transplantation are controversial.
“Regarding the association between obesity and graft loss as well as morbidity, the findings are controversial (6, 10–13).”
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- Authors
- Nicoletto, B. B., Fonseca, N. K. O., Manfro, R. C., Gonçalves, L. F. S., Leitão, C. B., & Souza, G. C.
- Affiliations
- Universidade Federal do Rio Grande do Sul (BR)
- Corresponding author
- Souza, Gabriela C.
- Venue
- Transplantation
- Published
- 2014-07-27
- Volume
- 98
- Issue
- 2
- Pages
- 167-176
- ISSN
- 0041-1337 (ISSN-L)
- OpenAlex
- W1975824792
- Cited by
- 193
- References
- 47
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 9 · 2023: 18 · 2022: 11 · 2021: 22 · 2020: 15 · 2019: 17 · 2018: 17 · 2017: 17 · 2016: 18 · 2015: 21 · 2014: 1 · 2013: 1
- FWCI
- 3.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Organ Donation and Transplantation
- Keywords
- obesity, kidney transplantation, delayed graft function, acute rejection, graft loss, patient survival, cardiovascular mortality, all-cause mortality, transplant outcomes
- MeSH terms
- Cardiovascular Diseases, Graft Rejection, Graft Survival, Humans, Obesity, Risk Factors, Time Factors, Chi-Square Distribution, Odds Ratio, Kidney Transplantation, Treatment Outcome, Risk Assessment, Delayed Graft Function
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