@article {4940,
	title = {Implications of excess weight on kidney donation: Long-term consequences of donor nephrectomy in obese donors},
	volume = {164},
	year = {2018},
	month = {Nov},
	abstract = {Background: An elevated body mass index (>30 kg/m2) has been a relative contraindication for living kidney donation; however, such donors have become more common. Given the association between obesity and development of diabetes, hypertension, and end-stage renal disease, there is concern about the long-term health of obese donors.
Methods: Donor and recipient demographics, intraoperative parameters, complications, and short- and long-term outcomes were compared between contemporaneous donors-obese donors (body mass index >=30 kg/m2) versus nonobese donors (body mass index <30 kg/m2).
Results: Between the years 1975 and 2014, we performed 3,752 donor nephrectomies; 656 (17.5\%) were obese donors. On univariate analysis, obese donors were more likely to be older (P < .01) and African American (P < .01) and were less likely to be a smoker at the time of donation (P = .01). Estimated glomerular filtration rate at donation was higher in obese donors (115 {\textpm} 36 mL/min/1.73m2) versus nonobese donors (97 {\textpm} 22 mL/min/1.73m2; P < .001). There was no difference between groups in intraoperative and postoperative complications; but intraoperative time was longer for obese donors (adjusted P < .001). Adjusted postoperative length of stay (LOS) was longer (adjusted P = .01), but after adjustment for donation year, incision type, age, sex, and race, there were no differences in short-term (<30 days) and long-term (>30 days) readmissions. Estimated glomerular filtration rate and rates of end-stage renal disease were not significantly different between donor groups >20 years after donation (P = .71). However, long-term development of diabetes mellitus (adjusted hazard ratio (HR) 3.14; P < .001) and hypertension (adjusted hazard ratio (HR) 1.75; P < .001) was greater among obese donors and both occurred earlier (diabetes mellitus: 12 vs 18 years postnephrectomy; hypertension: 11 vs 15 years).
Conclusion: Obese donors develop diabetes mellitus and hypertension more frequently and earlier than nonobese donors after donation, raising concerns about increased rates of end-stage renal disease.},
	doi = {10.1016/j.surg.2018.07.015},
	author = {Serrano, OK and Sengupta, B and Bangdiwala, A and Vock, DM and Dunn, TB and Finger, EB and Pruett, TL and Matas, AJ and Kandaswamy, R}
}
