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Obesity following kidney transplantation and steroid avoidance immunosuppression

Authors

  • Eric A. Elster,

    1. Transplantation Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
    2. Combat Casualty Care Directorate, Naval Medical Research Center, United States Navy, Silver Spring, MD
    3. Organ Transplant Service, Walter Reed Army Medical Center, United States Army, Washington, DC
    4. Uniformed Services University, Bethesda, MD
    5. Department of Surgery, National Naval Medical Center, United States Navy, Bethesda, MD
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  • David B. Leeser,

    1. Transplantation Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
    2. Organ Transplant Service, Walter Reed Army Medical Center, United States Army, Washington, DC
    3. Uniformed Services University, Bethesda, MD
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  • Craig Morrissette,

    1. Walter Reed Army Institute of Research, United States Army, Silver Spring, MD, USA
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  • Joseph M. Pepek,

    1. Combat Casualty Care Directorate, Naval Medical Research Center, United States Navy, Silver Spring, MD
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  • Albin Quiko,

    1. Uniformed Services University, Bethesda, MD
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  • Douglas A. Hale,

    1. Transplantation Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
    2. Organ Transplant Service, Walter Reed Army Medical Center, United States Army, Washington, DC
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  • Christine Chamberlain,

    1. Transplantation Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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  • Christine Salaita,

    1. Transplantation Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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  • Allan D. Kirk,

    1. Transplantation Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
    2. Organ Transplant Service, Walter Reed Army Medical Center, United States Army, Washington, DC
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  • Roslyn B. Mannon

    1. Transplantation Branch, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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  • The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Navy, the Department of Defense or the US Government.

Corresponding author: Eric Elster, MD, FACS, 503 Robert Grant Avenue, Silver Spring, MD, USA.
Tel.: +1 301 319 8632; fax: +1 301 295 1403;
e-mail: eric.elster@med.navy.mil

Abstract

Abstract:  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.

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