Kidney Week

Abstract: TH-PO144

Association of Visceral Obesity After Kidney Transplantation with Graft Survival in Living Kidney Transplant Recipients: A Retrospective Cohort Study

Session Information

• Transplantation: Cardiovascular and Metabolic Diseases
  October 25, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 1802 Transplantation: Clinical

Authors

• Tai, Reibin, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan

Reibin Tai,

• Ohashi, Yasushi, Sakura Medical Center, School of Medicine, Toho University, Chiba, Japan

Yasushi Ohashi,

• Muramatsu, Masaki, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan

Masaki Muramatsu,

• Kawamura, Takeshi, Sakura Medical Center, School of Medicine, Toho University, Chiba, Japan

Takeshi Kawamura,

• Shiraga, Nobuyuki, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan

Nobuyuki Shiraga,

• Shishido, Seiichiro, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan

Seiichiro Shishido,

• Sakai, Ken, School of Medicine, Faculty of Medicine, Toho University, Tokyo, Japan

Ken Sakai,

Background

Excessive weight gain is common after kidney transplantation. However, the relationship between visceral obesity and kidney allograft outcome remains unclear. We measured the visceral fat area by computed tomography and examined the relation with the kidney allograft survival.

Methods

We identified 254 recipients who underwent living kidney transplantation from 2004 to 2014. Of those, 196 recipients evaluated metabolic risk factors and visceral fat area at the level of the umbilicus on abdominal computed tomography before transplantation and 12 months after transplantation and were followed until February 2018. Visceral obesity was defined as visceral fat area of ≥100cm². Metabolic syndrome was defined by the NCEP ATP III criteria modified for the Japanese population. Treatment-resistant hypertension was defined as an office blood pressure of ≥130/80 mmHg, despite receiving ≥3 antihypertensives including diuretics, or ≥4 drugs usage. The adverse graft outcomes were defined as a decline of 50% or more of estimate glomerular filtration rate with baseline one month after transplantation or initiation of renal replacement therapy.

Results

Recipients with visceral obesity were seen in 69 (35.2%) at 12 months post-transplantation. Compared to recipients with no visceral obesity, they were more likely to be male, older, have a higher weight gain from 1 month to 12 months after kidney transplantation (7.0 ± 7.5 vs. 4.6 ± 8.8%, P <0.05), prevalence of metabolic syndrome (23.2 vs. 3.9%, P <0.01), and treatment-resistant hypertention (17.4 vs. 7.1%, P <0.05), and have a lower glomerular filtration (44 ± 12 vs. 48 ± 15 ml/min/1.73m², P <0.05). During median 9.5-year follow-up, they also had higher adverse graft outcome (3.2 vs 1.3 per 100 patient-years, P <0.05). In multivariate analysis, visceral obesity independently remained as a risk factor for kidney allograft outcome (hazard ratio, 2.27 ; 95% confidence interval, 1.11－4.72, P=0.033).

Conclusion

Visceral obesity at 1 year post-transplantation becomes a risk factor for metabolic syndrome and graft survival, which emphasizes the importance of management of obesity after transplantation.