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Obesity is a risk factor for progression to kidney transplant waitlisting after liver transplantation
Author(s) -
Locke Jayme E.,
Shelton Brittany,
Orandi Babak,
Olthoff Kim,
Pomfret Elizabeth,
Forde Kimberly A.,
Sawinski Deirdre,
Gray Meagan,
Ascher Nancy
Publication year - 2021
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14317
Subject(s) - medicine , obesity , transplantation , renal function , risk factor , steatohepatitis , cirrhosis , kidney disease , kidney , gastroenterology , kidney transplantation , liver transplantation , fatty liver , disease
Abstract Background Non‐alcoholic steatohepatitis has emerged as a leading cause of cirrhosis, and obesity‐associated comorbidities, including renal disease, have increased in prevalence. Obesity predisposes the kidney to hyperfiltration injury, potentially impairing acute kidney injury recovery. Identification of patients at risk for renal dysfunction is impeded by poor performance of renal function estimating equations among cirrhotics. To better understand obesity among cirrhotics and renal disease progression, we examined likelihood of kidney transplantation (KT) waitlisting after liver transplant alone (LTA) by obesity class. Methods 68 607 LTA recipients were identified in SRTR (2005–2018). Fine and Gray competing risks models were used to analyze likelihood of KT waitlisting. Results 27.4% of recipients were obese (BMI ≥ 30 kg/m 2 ) and were 10% more likely to require KT waitlisting (aHR: 1.10, 95%CI: 1.01–1.20). Risk was highest among recipients with Classes II and III obesity (BMI: ≥35 kg/m 2 ) (aHR: 1.37, 95%CI: 1.17–1.56). Moreover, recipients with Classes II and III obesity were 57% more likely to require KT waitlisting within one year post‐LTA (aHR: 1.57, 95%CI: 1.18–2.10) compared to non‐obese recipients. Discussion These findings suggest obesity was a risk factor for renal recovery failure and/or renal disease progression post‐LTA and may confound identification of renal dysfunction and/or prediction of renal recovery among cirrhotics.