Purpose: The increase of obesity among patients with end-stage renal disease poses a major challenge for urologists and nephrologists. Many centers set an upper limit on body mass index (BMI) to place a patient on the active waiting list due to worse outcomes regarding delayed graft function (DGF), acute rejection episodes and graft survival. However, obesity is also related to wound infection and parietal complications. This study was undertaken to determine the risk of early and late wound complications among obese patients undergoing renal transplantation.

Methods: 2,212 renal transplant recipientsfrom January 1995 to October 2013 were retrospectively reviewed. Combined transplantations and children were excluded. Recipients were classified based on BMI at the time of transplantation: underweight (BMI < 20 kg/m2), normal weight (20 ≤ BMI < 25), overweight (25 ≤ BMI < 30), class I obese (30 ≤ BMI < 35), class II obese (35 ≤ BMI < 40) and class III obese (BMI ≥ 40). The analysis included wound or renal site infection, superficial parietal dehiscence, fascial dehiscence (eventration, evisceration or incisional hernia), need for intervention and hospital stay.

Results: In total, there were 231 events in 226 patients. Multivariable logistic regression indicated a significantly increased risk for early and late wound complications. Risk exponentially increased 1.9-fold for each 5 points of BMI (p<0.001), reaching 17.5, 29.0, 45.0 and 60% with BMIs of 30, 35, 40 and 45, respectively. Wound infection and evisceration were the complications most associated with the increasing BMI (2.0- and 2.7-fold for each 5 points of BMI, respectively. p<0.001), figure 1. Less than 50% of wound infections and superficial dehiscence events require intervention, while the others events require intervention almost 100% of the time. Among the complications, there was no difference in patient hospitalization (26.2 ± 20.4; P= 0.42).

Conclusions: In this large series, it was shown that obesity greatly increases early and late wound complications and is associated with a higher necessity of reoperations. Although renal transplant centers cannot deny recipients based only on high BMIs, efforts are needed to assist patients on the waiting list to achieve weight loss, which would consequently decrease post-transplantation morbidity.

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