What Is the Implication of Pre-Donation Weight Loss to the Post-Donation Weight

[Clark]

http://www.atcmeetingabstracts.com/abstract/what-is-the-implication-of-pre-donation-weight-loss-to-the-post-donation-weight-and-outcome-of-living-donors/

What Is the Implication of Pre-Donation Weight Loss to the Post-Donation Weight and Outcome of Living Donors
A. Marsden, N. Waldron, R. Cooke, R. Chavez, A. Asderakis

Background: Living donors represent a third of kidney transplants performed in UK. A large proportion of potential donors are overweight but a number of those lose the weight required in order to donate. There is a worry that regaining this weight might represent a risk for long-term complications.

Aim: To study whether obese potential donors are at greater risk of regaining the weight they lost post donation. In addition to evaluate the risk factors for post donation weight change, hypertension and worse kidney function.

Results: There were 121 donors who were worked up and donated over 6 years in a single centre. 63 additional donors of the same period who were worked up and followed up in other centres were excluded from analysis. There was a minimum donor follow up of 2 years. Median BMI at preassessment was 26.8 with 25% of patients having a BMI over 30.3 and 14% a BMI over 32. Patients with BMI at preassessment of greater than 30 lost 4.5% of their weight to donate and their loss in weight at donation was statistically different (from BMI 30.5 to a BMI of 27.7, p=0.005) from the rest of the patients. Patients weight change at 1 and 2 years is inversely related to the change of weight between preassessment and donation (p=0.002) and is independent of BMI group at preassessment and donation, gender or age. Univariate analysis shows that the change in the 2 yr weight depends on the weight at pre-assessment (p=0.002) and donation (p=0.002), the weight change (0.08) and smoking habit, R2 =0.5.

Regression analysis showed that the donor’s systolic BP at 2 years was predicted by the initial systolic BP, the change of weight at donation, the donor age, the donor weight at donation and preassessment, the weight change at 1 year compared to both preassessment and donation weight.

The change of creatinine at 2 years was dependent on the gender (0.03) and the weight gain at 2 years compared to donation (p=0.004) but not on the initial weight, the loss of weight to donate or the BP at either the preassessment or at 2 years.

Conclusion: This is the largest complete follow up study of the impact of predonation weight to medium term outcomes of those donors. It seems that obese donors lose the weight required to donate but some of it is regained with adverse impact on systolic and diastolic blood pressure and serum creatinine. Aggressive weight management is equally important post donation as it is to make live donation both feasible and safe.