Obesity in Living Kidney Donors: Clinical Characteristics and Outcomes in the Era of Laparoscopic Donor Nephrectomy

Julie K. Heimbach; Sandra J. Taler; Mikel Prieto; Fernando G. Cosio; Stephen C. Textor; Yogish C. Kudva; George K. Chow; Michael B. Ishitani; Timothy S. Larson; Mark D. Stegall

Disclosures

American Journal of Transplantation. 2005;5(5):1057-1064. 

In This Article

Abstract and Introduction

Acceptance of obese individuals as living kidney donors is controversial related to possible increased risk for surgical complications and concern that obesity may contribute to long-term renal disease. We retrospectively examined 553 consecutive hand-assisted laparoscopic living kidney donations between October 1, 1999 and April 1, 2003. We stratified donors into quartiles by baseline body mass index (BMI) assessing perioperative complications and 6-12 months post-donation metabolic and renal function. Compared to BMI < 25 kg/m2, high BMI donors (≥ 35 kg/m2) had slightly longer operative times (mean increase 19 min), more overall perioperative complications (mostly minor wound complications), yet the same low rate of major surgical complications (conversion to open and re-operation) and similar length-of-stay (2.3 vs. 2.4 days). At 6-12 months after donation (mean 11 months), renal function and microalbuminuria did not differ with BMI. These results suggest that laparoscopic donor nephrectomy is generally safe in selected obese donors and does not result in a high rate of major perioperative complications. Obese donors have higher baseline cardiovascular risk and warrant risk reduction for long-term health. While early results are encouraging, we advocate careful study of obese donors and do not support their widespread use until longer follow-up is available.

Over the past 30 years, the short- and long-term outcomes for living kidney donors have been excellent, although donation has generally been restricted to a selected donor group with near optimal health.[1] Superior outcomes for recipients of living donor allografts combined with increasing deceased donor waiting times and a rise in prevalence of obesity have forced re-examination of donor selection criteria to consider obese individuals (body mass index (BMI) ≥ 30 kg/m2) who are otherwise in good health. Open surgical nephrectomy in obese subjects is associated with higher rates of post-operative complications, primarily wound related.[2] The introduction of laparoscopic techniques facilitates use of obese donors and initial reports of laparoscopic nephrectomy describe comparable operative success to non-obese patients.[3,4] Some centers report longer operative times and higher conversion rates for obese donors, though most complications are minor.[5] Little is known about the baseline clinical characteristics and subsequent outcomes for obese donors beyond the perioperative period.

Based upon our living donor experience in the era of laparoscopic nephrectomy, we sought to examine cardiovascular risk factors, renal function and surgical outcomes of renal donation and their relation to obesity, using BMI as a standardized marker for the extent of obesity. We report results of a retrospective analysis of 553 consecutive living renal donors who underwent laparoscopic donor nephrectomy between 1999 and 2003 analyzed by quartiles according to BMI.

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