Is obesity a contraindication for kidney donation?
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and Other Interventional Techniques
2019 SAGES ORAL
Is obesity a contraindication for kidney donation? Lilli Schussler1 · Prerna Khetan1 · Matthew Peacock1 · Elisha Dickstein2 · Dianne LaPointe‑Rudow3 · Michael Palese4 · Antonios Arvelakis3 · Daniel Herron1 · Ron Shapiro3 · Sander Florman3 · Edward H. Chin1,5 Received: 7 May 2019 / Accepted: 9 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Introduction To enlarge the donor pool, kidney donors with obesity have been considered. We hypothesized that it is safe for patients with obesity to serve as living kidney donors. Methods In this single-center retrospective analysis, we examined the effect of obesity (body mass index (BMI) of 30–35 kg/ m2) on glomerular filtration rate (GFR) and creatinine in patients undergoing laparoscopic donor nephrectomy. Other outcomes included intraoperative, 30-, and 90-day complications. We examined the trajectory between patients with obesity versus patients without obesity over time using mixed effects models for the outcomes of creatinine in mg/dL and GFR in mL/min/1.73 m2. Results Among donors with obesity versus donors without obesity, there were no significant differences in demographics or comorbidities. Baseline creatinine in donors with obesity was significantly greater than that of donors without obesity (p = 0.02). Operative time was significantly longer in donors with obesity versus without obesity (p = 0.03). There was no significant difference in 30-day morbidity between donors with obesity versus without obesity (6.52 vs. 3.57%, respectively; p = 0.38). The rate of graft complications was 8.7% in donors with obesity versus 7.1% in donors without obesity (p = 1.0). 90-day complications were infrequent, and not significant different between the groups. At 6, 12, and 24-month postoperative follow-up, the mean creatinine level in patients with obesity was not significantly different from that of patients without obesity (1.23 vs. 1.31, 1.23 vs. 1.26, and 1.17 vs. 1.19 at 6, 12, and 24 months, respectively). Mean GFR was also not significantly different at 6, 12, and, 24 months. Conclusion Postoperative creatinine and GFR changes were not significantly different in patients with obesity versus without obesity after laparoscopic donor nephrectomy. These findings suggest that carefully screened living kidney donors with obesity do not experience decreased postoperative renal function. Keywords Donor · Donor nephrectomy · Obesity · Transplantation · Renal function · Creatinine Chronic kidney disease affects 10% of American adults, with 600,000 patients on dialysis treatment and 94,898 patients registered on the active waiting list of the United Network for Organ Sharing (UNOS) as of 2018 [1]. Of the 21,167 * Edward H. Chin [email protected] 1
Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
2
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
3
Recanati Miller Transplantation Institute, Mo
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