title: Complex kidneys for complex patients: the risk associated with transplantation of kidneys with multiple arteries into obese patients.
abstract: Conflicting evidence surrounds clinical outcomes in obese individuals after transplantation; nonetheless, many are denied the opportunity to receive a transplant. Allografts with complex vascular anatomy are regularly used in both deceased and living donor settings. We established the risk of transplanting kidneys with multiple renal arteries into obese recipients. A retrospective analysis of data from 1095 patients undergoing renal transplantation between January 2004 and July 2013 at a single centre was conducted. Of these, 24.2% were obese (body mass index >30 kg/m(2)), whereas 25.1% of kidneys transplanted had multiple arteries, thereby making the transplantation of kidneys of complex anatomy into obese recipients a relatively common clinical occurrence. Vessel multiplicity was associated with inferior 1-year graft survival (85.8.% vs 92.1%, P = .004). Obese patients had worse 1-graft survival compared to those of normal BMI (86.8% vs 93.8%, P = .001). The risk of vascular complications and of graft loss within a year after transplantation were greater when grafts with multiple arteries were transplanted into obese recipients as compared to their nonobese counterparts (RR 2.00, CI 95% 1.07-3.65, and RR 1.95, CI 95% 1.02-3.65). Additionally, obese patients faced significantly higher risk of graft loss if receiving a kidney with multiple arteries compared to one of normal anatomy (RR 1.97, 95% CI 1.02-3.72). Thus, obese patients receiving complex anatomy kidneys face poorer outcomes, which should be considered when allocating organs, seeking consent, and arranging for aftercare.
authors.affiliation: Department of Renal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom. Electronic address: j.nath@bham.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: Nath
authors.affiliation: Department of Renal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Mastoridis
authors.affiliation: Department of Renal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: van Dellen
authors.affiliation: Department of Renal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; School of Immunity and Infection, University of Birmingham, Birmingham, United Kingdom.
authors.forename: A J
authors.initials: AJ
authors.lastname: Guy
authors.affiliation: Department of Renal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
authors.forename: D G
authors.initials: DG
authors.lastname: McGrogan
authors.affiliation: Department of Renal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
authors.forename: H
authors.initials: H
authors.lastname: Krishnan
authors.affiliation: Department of Renal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Pattenden
authors.affiliation: Department of Renal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
authors.forename: N G
authors.initials: NG
authors.lastname: Inston
authors.affiliation: Department of Renal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
authors.forename: A R
authors.initials: AR
authors.lastname: Ready
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000098:blood supply / Q000601:surgery; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000209:etiology; D012077:Renal Artery / Q000002:abnormalities*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D016896:Treatment Outcome