Surgical complications and graft survival in kidney transplant recipients according to CT-scans evaluation

Obesity is a risk factor for significant surgical complications following kidney transplantation. We examined morphometric parameters other than the body mass index (BMI) that could predict surgical complications and determine their impact on graft survival.

Kidney transplantations performed at our center between 2012 and 2019 were retrospectively evaluated. Data for visceral adipose tissue (VAT), subcutaneous adipose tissue, psoas surface, abdominal perimeter (AP), and vessel-to-skin distance (VSK) were collected from pre-transplant computed tomography (CT) scans. The primary outcome was the occurrence of surgical complications within 1 year of transplantation; the secondary outcome was graft survival.

We included 321 (88%) of 364 kidney transplant recipients, of which 154 (46.5%) patients experienced some form of surgical complication in the 1st year of follow-up. Univariate analysis revealed that higher VAT (P=0.004), VSK (P=0.007), and AP (P=0.01) values were potential risk factors for early postoperative morbidity. However, none of these factors were significant in the multivariate analysis. Concerning the secondary outcome, while the univariate analysis identified higher VAT (P=0.001) value as a risk factor, in the multivariate analysis only delayed graft function demonstrated a significant impact on graft survival (P=0.002).

Although morphological parameters showed greater accuracy in predicting surgical complications in univariate analysis, these results were not significant in multivariate analysis. Moreover, these factors were not significantly associated with graft survival. Therefore, routine application of analyses based on these parameters, regardless of BMI, may not be useful.