Obesity following kidney transplantation and steroid avoidance immunosuppression

• Published in: Clinical transplantation 2008-05, Vol.22 (3), p.354-359
• Main Authors: Elster, Eric A., Leeser, David B., Morrissette, Craig, Pepek, Joseph M., Quiko, Albin, Hale, Douglas A., Chamberlain, Christine, Salaita, Christine, Kirk, Allan D., Mannon, Roslyn B.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Alemtuzumab; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm - administration & dosage; Antilymphocyte Serum; Biological and medical sciences; Body Mass Index; end-stage renal disease; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; immunosuppression; Immunosuppression - methods; Immunosuppressive Agents - administration & dosage; Kidney Transplantation; Male; Medical sciences; Metabolic diseases; Middle Aged; Mycophenolic Acid - administration & dosage; Mycophenolic Acid - analogs & derivatives; Obesity; Obesity - etiology; Obesity - prevention & control; Risk Factors; Sirolimus - administration & dosage; steroid avoidance; Steroids - administration & dosage; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tacrolimus - administration & dosage; Tissue, organ and graft immunology
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2008.00792.x

:  Obesity is an important co‐morbidity within end‐stage renal disease (ESRD) and renal transplant populations. Previous studies have suggested that chronic corticosteroids result in increased body weight post‐transplant. With the recent adoption of steroid‐sparing immunosuppressive strategies, we evaluated the effect of these strategies on body mass index (BMI) after renal transplantation. We examined 95 renal transplant recipients enrolled in National Institutes of Health clinical transplant trials over the past three yr who received either lymphocyte depletion‐based steroid sparing or traditional immunosuppressive therapy that included steroids for maintenance immunosuppression. Recipients were overweight prior to transplant and no significant differences existed in pre‐transplant BMI among treatment groups. Regardless of therapy, BMI increased post‐transplant in all recipients. The BMI increase consisted of an average weight gain of 5.01 ± 7.12 kg (mean, SD) post‐transplant. Additionally, in a number of recipients placed on maintenance steroids, subsequent withdrawal at a mean of 100 d post‐transplant had no impact on weight gain. Thus, body weight and BMI increase following kidney transplantation, even in the absence of steroids. Thus, patients gain weight after renal transplantation regardless of the treatment strategy. Steroid avoidance alone does not reduce risk factors associated with obesity in our patient population.