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Long-Term Renal Function and Cardiovascular Disease Risk in Obese Kidney Donors

Mohammad M. Tavakol^*, Flavio G. Vincenti, Hamid Assadi^*, Michael J. Frederick^*, Stephen J. Tomlanovich, John P. Roberts^*, and Andrew M. Posselt^*

^* Division of Transplantation Surgery, Department of Surgery, and Division of Nephrology, Department of Internal Medicine, University of California, San Francisco, San Francisco, California

Correspondence: Dr. Andrew M. Posselt, Division of Transplant Surgery, University of California, San Francisco, 505 Parnassus Avenue, Room M896, San Francisco, CA 94143. Phone: 415-353-1473; Fax: 415-353-8709; E-mail: andrew.posselt{at}ucsfmedctr.org

Background and objectives: Increasing demand for live-donor kidneys has encouraged the use of obese donors despite the absence of long-term outcome data and evidence that obesity can adversely affect renal function. We wished to determine whether obesity increased the risk for renal dysfunction and other medical comorbidities in donors several years after donation.

Design, setting, participants, & measurements: Ninety-eight patients who donated a kidney 5 to 40 years previously were stratified according to body mass index (BMI) at donation and evaluated for renal dysfunction and risk factors for cardiovascular disease. Patients who were from the 2005 through 2006 National Health and Nutrition Examination Survey database; did not have renal disease; and were matched for age, gender, race, and BMI served as two-kidney control subjects.

Results: Renal function in obese (BMI 30) and nonobese (BMI <30) donors was similar, and both donor groups had reduced renal function compared with BMI-matched two-kidney control subjects. Obesity was associated with more hypertension and dyslipidemias in both donors and two-kidney control subjects; however, there were no significant differences between the two groups within each BMI category.

Conclusions: These results indicate that obese donors are not at higher risk for long-term reduced renal function compared with nonobese donors and that the increased incidence of hypertension and other cardiovascular disease risk factors in obese donors is due to their obesity and is not further exacerbated by nephrectomy. These findings support the current practice of using otherwise healthy overweight and obese donors but emphasize the need for more intensive preoperative education and postoperative health care maintenance in this donor group.