Is obesity a contraindication for kidney donation?

Lilli Schussler; Prerna Khetan; Matthew Peacock; Elisha Dickstein; Dianne LaPointe-Rudow; Michael Palese; Antonios Arvelakis; Daniel Herron; Ron Shapiro; Sander Florman; Edward H Chin

doi:10.1007/s00464-019-07218-7

Is obesity a contraindication for kidney donation?

Surg Endosc. 2020 Oct;34(10):4632-4637. doi: 10.1007/s00464-019-07218-7. Epub 2019 Oct 21.

Authors

Affiliations

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, Mount Sinai Hospital, New York, NY, USA.
⁴ Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁵ Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Edward.chin@mountsinai.org.
⁶ , 5 E 98th St, Box 1259, New York, NY, 10029, USA. Edward.chin@mountsinai.org.

PMID: 31637602
DOI: 10.1007/s00464-019-07218-7

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 m^2. 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: Creatinine; Donor; Donor nephrectomy; Obesity; Renal function; Transplantation.

MeSH terms

Adult
Female
Humans
Kidney Transplantation / ethics*
Male
Obesity / complications*
Postoperative Period
Retrospective Studies
Robotics / methods*
Tissue and Organ Harvesting / statistics & numerical data*