Abstract
Weight gain within the first year of kidney transplantation is associated with adverse outcomes. This narrative systematic review and meta-analysis examines the effect of exercise, physical activity, dietary, and/or combined interventions on body weight and body mass index (BMI) within the first year of kidney transplantation. Seven databases were searched from January 1985 to April 2021 (Prospero ID: CRD42019140865), using a ‘Population, Intervention, Controls, Outcome’ (PICO) framework. The risk-of-bias was assessed by two reviewers. A random-effects meta-analysis was conducted on randomized controlled trials (RCTs) that included post-intervention body weight or BMI values. Of the 1197 articles screened, sixteen met the search criteria. Ten were RCTs, and six were quasi-experimental studies, including a total of 1821 new kidney transplant recipients. The sample sizes ranged from 8 to 452. Interventions (duration and type) were variable. Random-effects meta-analysis revealed no significant difference in post-intervention body weight (−2.5 kg, 95% CI −5.22 to 0.22) or BMI (−0.4 kg/m2, 95% CI −1.33 to 0.54). Despite methodological variance, statistical heterogeneity was not significant. Sensitivity analysis suggests combined interventions warrant further investigation. Five RCTs were classified as ‘high-risk’, one as ‘some-concerns’, and four as ‘low-risk’ for bias. We did not find evidence that dietary, exercise, or combined interventions led to significant changes in body weight or BMI post kidney transplantation. The number and quality of intervention studies are low. Higher quality RCTs are needed to evaluate the immediate and longer-term effects of combined interventions on body weight in new kidney transplant recipients.
Highlights
Weight gain within the first year of solid organ transplantation has been associated with adverse clinical events and poor transplant outcomes [1,2]
Whilst weight gain presents as a clinical issue for all solid organ transplant (SOT) recipients, the experiences of weight gain vary across the SOT groups
Results from a recent United Kingdom (UK) survey of all transplant centres revealed clinicians believed that kidney transplant outcomes were adversely affected by obesity
Summary
Weight gain within the first year of solid organ (kidney, liver, heart, and lung) transplantation has been associated with adverse clinical events and poor transplant outcomes [1,2]. Liver transplant recipients tend to have a reduction in body weight in the first six months associated with the removal of ascites, followed by a period of weight gain [3]. Kidney, heart, and lung transplant recipients demonstrate rapid weight gain in the acute-post operative period [3]. A retrospective analysis of 25,539 adult kidney transplant recipients (KTRs) in the United Kingdom (UK) reported a BMI of greater than 25 kg/m2 was an independent risk factor for both delayed graft function and primary graft non-function [4]. Underweight and obese KTRs were reported to have poorer graft survival [4]
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