Presentation Authors: Affonso Celso Piovesan*, Felipe Hirasaki, Rogerio Heggendorn Sayao Filho, Felipe Saraiva Bernardes, Alexandre Sallum Bull, Gustavo Beojone Messi, Gustavo Xavier Ebaid, Hideki Kanashiro, Ioannis Michel Antonopoulos, Renato Falci Júnior, Kleiton Gabriel Ribeiro Yamaçake, Rafael Fagionato Locali, William Carlos Nahas, São Paulo, Brazil
Introduction: The increase of obesity among patients with end-stage renal disease poses a major challenge for urologists and nephrologists. Many centers set an upper limit on body mass index (BMI) to place a patient on the active waiting list due worse outcomes regarding delayed graft function (DGF), acute rejection episodes and graft survival. However, obesity is also related to a higher risk of surgical complications. This study was undertaken to determine the increase risk of surgical complications in relation to BMI.
Methods: This study was a retrospective review of 2,212 renal transplant recipients in a single-institution database from January 1999 to October 2017. Combined transplantations and children were excluded. Recipients were classified based on BMI at the time of transplantation: non-obese (BMI < 25 kg/m2), overweight (25 â‰¤ BMI < 30), class I obese (30 â‰¤ BMI < 35), class II obese (35 â‰¤ BMI < 40) and class III obese (BMI â‰¥ 40). The analysis included vascular, ureteral, wound infection, parietal dehiscence (superficial, eventration and evisceration), incisional hernia, need for intervention and hospital stay.
Results: In total, there were 231 events in 226 patients. Multivariable logistic regression indicated significantly increased risk for early and late wound complications. Risk increased 1.9-fold for each 5 points of BMI (p < 0.001), reaching 17.5, 29.0, 45.0 and 60% with BMIs of 30, 35, 40 and 45, respectively. Wound infection and evisceration were the complications most associated with the increasing BMI (2.0- and 2.7-fold for each 5 points of BMI, respectively. p < 0.001), figure 1. Less than 50% of wound infections and superficial dehiscence events require intervention, while the others events require intervention almost 100% of the time. Among the complications, there was no difference in patient hospitalization (26,2 Â± 20,4; P= 0.42). The was also no difference in incidence of vascular and ureteral complications with a overall incidence of 0,7 and 1,5%.
Conclusions: In this large series, we show that obesity greatly increases early and late wound complications and is associated with a higher necessity of reoperations. Based on this data we avoid kidney transplant surgery in patients with IMC > 40.