PD54-07 IMPACT OF OBESITY ON SURGICAL COMPLICATIONS OF KIDNEY TRANSPLANT. SHOULD WE SITILL TRANSPLANT MORBITY OBESITY PATIENTS?

Abstract

INTRODUCTION AND OBJECTIVES: 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. METHOD(S): 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 < BMI < 30), class I obese (30 < BMI < 35), class II obese (35 < BMI < 40) and class III obese (BMI > 40). The analysis included vascular, ureteral, wound infection, parietal dehiscence (superficial, eventration and evisceration), incisional hernia, need for intervention and hospital stay. RESULT(S): 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 +/- 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%. CONCLUSION(S): 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.