Obesity in kidney transplantation.
Kidney transplantation is the preferred modality of renal replacement therapy. Long-term patient and graft survival have only improved marginally over the recent decade, mainly because of the development of cardiovascular disease after transplantation. Obesity is a risk factor for cardiovascular disease and is common before and after transplantation. This article reviews the literature assessing the role of pre- and post-transplant obesity on patient and graft survival, discusses the underlying obesity-related mechanisms leading to inferior kidney transplant outcomes, and explores the role of nutritional intervention on improving long-term outcomes of transplantation. Although the role of pretransplant obesity remains uncertain, post-transplant obesity increases the risk of graft failure and mortality. Nutritional intervention is effective in achieving post-transplant weight loss, but the effect on long-term outcomes has not been established. Future research should focus on conducting nutritional intervention studies aiming to improve long-term outcomes of kidney transplantation.
Department of Nutrition and Dietetics, Therapy Services South Suite, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; School of Sport and Exercise Sciences, University of Birmingham, Birmingham, United Kingdom. Electronic address: Winnie.Chan@uhb.nhs.uk.
Winnie
W
Chan
School of Sport and Exercise Sciences, University of Birmingham, Birmingham, United Kingdom.
Jos A
JA
Bosch
School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom.
David
D
Jones
Division of Metabolic and Vascular Health, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
Philip G
PG
McTernan
School of Sport and Exercise Sciences, University of Birmingham, Birmingham, United Kingdom.
Anna C
AC
Phillips
Centre for Translational Inflammation Research, University of Birmingham, Birmingham, United Kingdom; Department of Nephrology and Kidney Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
Richard
R
Borrows
D000818:Animals; D001823:Body Composition; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications; D004195:Disease Models, Animal; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality*; D008019:Life Style; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D016896:Treatment Outcome