Abstract
Introduction: Commensurate with obesity having become a ‘pandemic’ of current times, our recipient selection criteria are becoming increasingly liberalized to include recipients with higher body mass index (BMI). Obesity can pose a technical challenge. How has this impacted the outcomes of simultaneous kidney-pancreas transplantation (SPKTx)? Methods: A retrospective study on SPKTx performed at a single centre from Dec 1996 to August 2011. Up to February, 2006, the SPKTx were systemic-bladder drained, and after that date, they were systemic-enteric drained. Recipients with body mass index (BMI) ≥ 30 (Obese group, n=28) were compared to recipients with BMI < 30 (Non-Obese group, n=152). The pertinent donor, recipient, transplant characteristics and post transplant outcomes were compared. Survival analysis was done using Kaplan Meier actuarial analysis. Results: The mean BMI of the Obese group was significantly higher than that of the Non-Obese group [33 (3) Obese versus 23 (3) Non-Obese, p< 0.0001]. The Obese group had significantly greater proportion of recipients with pancreas cold ischaemia time (CIT) > 12 hours (64% vs. 42%, p=0.02), slightly greater proportion of older recipients (aged > 40 years) (64% vs. 45%, p=0.056), and significantly lower proportion of female recipients (32% vs. 51%, p=0.06). The remaining characteristics were similar between the 2 groups. Actuarial analysis showed that there was no significant difference in the patient survival at 1 year (96% Obese vs. 99% Non-Obese) and 5 years (92% Obese vs. 96% Non-Obese), death-censored pancreas survival at 1 year (93% each) and 5 years (88% Obese vs. 87% Non-Obese), and death-censored kidney survival at 1 year (93% each) and 5 years (88% each, all P=NS). There was no significant difference between the 2 groups in terms of wound infection, intra-abdominal sepsis, urinary tract infection, bacteraemia episodes, peripancreatic fluid collections and early or late biopsy proven acute rejection episodes. Early graft loss from non-immunological causes was slightly greater in the Obese group compared to the Non-Obese group (18% vs. 10 %, p=0.2). There was a significantly higher rate of graft thrombosis in the Obese group compared to the Non-Obese group (14% Obese vs. 1% Non-Obese, p< 0.0001). Bleeding complication rates were similar between the 2 groups. Conclusion: The overall results of SPKTx in recipients with BMI > 30 are comparable to those with BMI < 30. However, the technical challenge faced during the operation may contribute to a higher cold ischaemia time and pancreas thrombosis in the obese recipients. The role of heparin in reducing the risk of thrombosis in this high risk category maybe considered, but our study was limited by small numbers, and would benefit from a larger series before a definite recommendation can be made.
Published Version
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