Abstract: TH-PO995

Metabolic Responses to Kidney Transplantation: Is Early Weight Gain Benign?

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Workeneh, Biruh, MD Anderson Cancer Center, Houston, Texas, United States
  • Nolte, Joy V, Houston Methodist Hospital, Houston, Texas, United States
  • Moore, Linda W., Houston Methodist Hospital, Houston, Texas, United States
  • Shypailo, Roman, Baylor College of Medicine, Houston, Texas, United States
  • Gaber, Ahmed Osama, Houston Methodist Hospital, Houston, Texas, United States
  • Mitch, William E., Baylor College of Medicine, Houston, Texas, United States
Background

It is widely assumed that modest weight gain following kidney transplantation (KT) is advantageous to patients. However, there is no consensus about what constitutes appropriate degree of weight gain nor has there been rigorous explorations about the nature and metabolic implications of changes in body composition.

Methods

We analyzed 31 living kidney transplant (KT) recipients. Subjects were 18-65yrs old, noninsulin dependent, and received tacrolimus-based immunosuppression. All measurements were obtained <1mo prior to and 3mo post-KT. DXA and BodPod were used to measure body mass and define body compartments. Resting energy expenditure (REE) was obtained by indirect calorimetry and physical activity was assessed by accelerometory. Insulin resistance (IR) was determined by HOMA-IR and dietary intake determined ASA24 dietary recall.

Results

We observed significant increases in body weight and fat (Table1). DXA revealed fat accumulation primarily in the truncal region. Visceral and subcutaneous fat volumes increased significantly, and visceral fat volume positively correlated with IR (r=0.452, p=0.012). REE did not change significantly and there was no relationship with fat or muscle mass. Accelerometry showed subjects were more ambulatory post-KT, 5201 vs 6515 average daily steps(p=0.034). Vector magnitude (total axis activity) also increased. Food recalls showed more calories comprised of fat and protein are consumed post-KT(42% and 17% of total kcals).

Conclusion

We conclude that only 3 months after KT there are small but significant increases in adipose deposition and have reported adverse responses including insulin resistance. Even at this early stage, patients accumulate total body fat and importantly, visceral fat. The changes we observed could not be attributed to changes in other body compartments, decreased metabolic rate, or physical activity but dietary factors may influence orexigenic factors and adipose tissue accumulation.

 Pre-KT (mean, (SD))Post-KT (mean, (SD))p-value
Weight, kg (SD)83.8 (16.6)85.3 (16.7)0.032
DXA fat, kg25 (10.7)27 (10)0.004
Trunk fat mass, kg13.4 (6.5)14.9 (6.3)000.1
Visceral fat volume, cm3839 (780)916 (482)0.006
Subcutaneous fat volume, cm31539 (689)1703 (602)0.002
Total daily calories1954 (978)2260 (776)0.240)
HOMA-IR2.92 (1.98)4.47 (3.6)0.012

Funding

  • Private Foundation Support