At time of nephrectomy, BP, age and renal function were similar between those that did and did not develop CKD. There were, however, significant differences
in BMI at the time of nephrectomy (BMI 24.9 kg/m2 in normal function group, compared with 33.7 kg/m2 in the abnormal renal function group). BMI was independently associated with proteinuria/renal dysfunction on multivariate analysis (OR 1.34, 95% CI: 1.03–1.76). At 10 years following nephrectomy, the probability of negative proteinuria and normal renal function was 40% and 70%, respectively, in the obese group and 93% and 98%, respectively, for the non-obese patients. It is important not to overinterpret this study, which is retrospective, has small numbers, is subject to ascertainment MAPK inhibitor bias and involved patients who may have had undiagnosed abnormalities of the remaining kidney. However, it does raise some uncertainty about the long-term safety of nephrectomy in obese donors. In attempting to modify the risks associated with nephrectomy, it is a logical step to advise obese donors
to lose weight prior to donation. In many cases, the perceived benefits of living donation for the recipient will be a strong motivating force. However, the success of sustained weight loss in the general population is low and there are no data on the long-term success rate of pre-donation weight loss.84,85 It is likely that obesity is associated with an increase in perioperative complications, such
as wound infections Selleckchem BGB324 and transfusion requirements. There are limited data on which to base recommendations for long-term safety of the procedure for patients with a BMI > 30 kg/m2 and none for patients with a BMI > 35 kg/m2. Most studies show that obese donors do have more adverse risk profiles, in particular a higher pre-donation BP and it is likely that there is a greater risk of donor hypertension. It is not known whether nephrectomy alters the risk of developing kidney disease or changes the rate of progression. Further studies need to be carried out to define risk. INTERNATIONAL GUIDELINES: The Amsterdam Forum on the Care of the Living Kidney Donor Cell press (2006)86 All living donors should have BMI determined at baseline evaluation and obesity should be considered an increased risk for renal disease, acknowledging that there are no data on which to base a firm recommendation. The Canadian Council for Donation and Transplantation (2006)87 There is debate regarding the eligibility of those with . . . donor BMI > 35. Little is known about either the long-term risks to such donors or the long-term outcome of kidneys from such donors. European Renal Association-European Dialysis and Transplant Association (2000) No recommendation. UK Guidelines for Living Donor Kidney Transplantation (2005)88 A BMI of more than 35 kg/m2 should be regarded as an absolute contraindication to kidney donation and a BMI of more than 30 kg/m2 is a relative contraindication.