Clinical Characteristics and Outcomes of Donor Nephrecomy for Obese Living Kidney Donors

Abstract

Introduction: Superior outcomes for recipients of live donor kidney transplantation and serious shortage of deceased-donors have led to a rise in the volume of live donor transplants, especially in Japan. Recently, there is increasing evidence that obese patients are more susceptible to the development of chronic kidney disease (CKD) either a direct result of their weight or as a consequence of their obesity-related comorbidities, such as hypertension and diabetes. Accordingly, recognition of increasing body mass index (BMI) as a risk factor for CKD, however, has raised concerns about the appropriateness of accepting obese live kidney donors. Open surgical nephrectomry in obese subjects is associated with higher rates of post-operation complicating, primarily wound related. Furthermore, some centers reported longer operative time and higher conversion rates for obese donors. Conversely, the introduction of laparoscopic techniques facilitates use of obese donors. Little is known about the baseline clinical characteristics and subsequent outcomes for obese donors beyond the perioperative period. Therefore, acceptance of obese individuals as living kidney donors is still controversial related to possible increased risk for surgical complications and concern that obesity may contribute to long-term kidney disease. Objectives: The primary objectives of this study was to address this issue by examining short-term outcomes for live donors according to BMI category (ie; nonobese [BMI< 25] and obese [BMI≥25]) at Osaka University Hospital (OUH). Materials and methods: The study involved a retrospective review of the records of living kidney donors who underwent donor laparoscopic nephrectomy at OUH during the period from 1/1/2005 through 12/31/2010. The institutional review board of OUH approved the data collection procedures for those individuals who had not declined use of their medical records for research at the time their clinical care commenced. Based on the information in the medical record, donors were divided into two groups according to BMI:< 25 kg/m2 and ≥25 kg/m2 for analysis. Surgical outcomes including operation time, operation bleeding and perioperative complications were compared across BMI group. Baseline clinical characteristics recorded at the time of donor evolution, including BMI, blood pressure, fasting plasma glucose, lipids levels and renal function wore compared across BMI groups. Results: The results are summarized in the table as described below.Table: [E Ueda et al. table for result]Conclusion: These results demonstrate that donor nephrectomy is generally safe in selected obese donors and does not result in a high rate of major perioperative complications. While early results are encouraging, we advocate careful study of long-term follow-up for obese donors and more intensive preoperative education and postoperative health care maintenance should be needed in obese donor groups.