Open Renal Transplantation in Obese Patients: A Correlation Study between BMI and Early and Late Complications with Implementation of a Prognostic Risk Score
Sara Marzorati,
Domenico Iovino,
Davide Inversini,
Valentina Iori,
Cristiano Parise,
Federica Masci,
Linda Liepa,
Mauro Oltolina,
Elia Zani,
Caterina Franchi,
Marika Morabito,
Mattia Gritti,
Caterina Di Bella,
Silvia Bisogno,
Alberto Mangano,
Matteo Tozzi,
Giulio Carcano,
Giuseppe Ietto
Affiliations
Sara Marzorati
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Domenico Iovino
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Davide Inversini
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Valentina Iori
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Cristiano Parise
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Federica Masci
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Linda Liepa
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Mauro Oltolina
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Elia Zani
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Caterina Franchi
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Marika Morabito
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Mattia Gritti
Department of General Surgery, Humanitas Clinical and Research Center, 20089 Rozzano, Italy
Caterina Di Bella
Kidney and Pancreas Transplantation Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, 35128 Padova, Italy
Silvia Bisogno
Department of Cardiologic Intensive Care, Hemodynamics and Cardiology, S.M. Goretti Hospital, Sapienza University of Rome, 04100 Latina, Italy
Alberto Mangano
Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60607, USA
Matteo Tozzi
Vascular Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Giulio Carcano
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Giuseppe Ietto
General, Emergency and Transplant Surgery Department, ASST-Sette Laghi, 21100 Varese, Italy
Background: Obesity is a global epidemic that affects millions worldwide and can be a deterrent to surgical procedures in the population waiting for kidney transplantation. However, the literature on the topic is controversial. This study evaluates the impact of body mass index (BMI) on complications after renal transplantation, and identifies factors associated with major complications to develop a prognostic risk score. Methods: A correlation analysis between BMI and early and late complications was first performed, followed by a univariate and multivariate logistic regression analysis. The 302 included patients were divided into obese (BMI ≥ 30 kg/m2) and non-obese (BMI ≤ 30 kg/m2) groups. Correlation analysis showed that delayed graft function (DGF) was the only obesity-associated complication (p = 0.044). Logistic regression analysis identified female sex, age ≥ 57 years, BMI ≥ 25 and ≥30 kg/m2, previous abdominal and/or urinary system surgery, and Charlson morbidity Score ≥ 3 as risk factors for significant complications. Based on the analyzed data, we developed a nomogram and a prognostic risk score. Results: The model’s area (AUC) was 0.6457 (95% IC: 0.57; 0.72). The percentage of cases correctly identified by this model retrospectively applied to the entire cohort was 73.61%. Conclusions: A high BMI seems to be associated with an increased risk of DGF, but it does not appear to be a risk factor for other complications. Using an easy-to-use model, identification, and stratification of individualized risk factors could help to identify the need for interventions and, thus, improve patient eligibility and transplant outcomes. This could also contribute to maintaining an approach with high ethical standards.
