A systematic review and meta-analysis of the relation between Body Mass Index and outcome in renal transplant recipients.
J.A. Lafranca, J. Ijzermans, M.G.H. Betjes, F.J.M.F. Dor
Moderator(s): M.H.L. Christiaans en E.J.P. de Koning
Location(s): Grote zaal
Category:
Background Whether overweight or obese end stage renal disease (ESRD) patients are eligible for renal transplantation is often debated. No (systematic) reviews have yet been carried out regarding this subject, and more specifically, surgical outcome of these patients. The aim of this review and meta-analysis is to systematically investigate outcome of low- versus high Body Mass Index (BMI) recipients after renal transplantation.
Methods Comprehensive searches were conducted in MEDLINE OvidSP, Embase, Web of Science, Google Scholar and CENTRAL (the Cochrane Library 2013, issue 5). A meta-analysis was performed by using Review Manager 5.2. Random-effects models were used. The methodology was in accordance with the Cochrane Handbook for Interventional Systematic Reviews, and written based on the PRISMA-statement. Results Forty-two studies were selected and reviewed. Thirty-seven outcome measures were reviewed (including over 90.000 recipients) and twenty-six could be meta-analysed. Of these, the following demonstrated significant differrences in favour of low BMI (<30) recipients: death (risk ratio (RR) 1.52; P = 0.008), delayed graft function (RR 1.57; P < 0.001), acute rejection (RR 1.19; P = 0.03), graft survival at 1 and 3 years (RR 0.96; P < 0.001 and RR 0.93; P = 0.001 respectively), patient survival at 1 and 3 years (RR 0.99; P < 0.001 and RR 0.99; P < 0.001 respectively), wound infection (RR 3.99; P < 0.001), NODAT (RR 1.90; P < 0.001), length of stay (RR 2.30; P < 0.001), hypertension (RR 1.36; P =0.001) and incisional hernia (RR 2.72; P = 0.04). Differences in other outcome parameters were not significant.
Conclusion This systematic review and meta-analysis is the first that combines a large number of articles and outcome measures in overweight and obese renal transplant recipients. Several of these show significant benefit for low BMI (<30) recipients. Therefore, we conclude that ESRD patients with a BMI >30 preferably should lose weight prior to RT. If this cannot be achieved with common measures, in morbidly obese RT candidates, bariatric surgery could be considered. Secondly, surgical outcome measures in these recipients should be further investigated.