Key result
A 5-variable morphometric model including BMI, visceral adipose tissue, vessel-to-skin distance, abdominal perimeter, and age predicted temporary contraindication with an AUC of 0.88.
Why the study?
BMI does not evaluate the intra- or extra-peritoneal distribution of fatty tissue and clinical examination is subjective when determining temporary contraindication for kidney transplantation in morbid obesity.
Do morphometric criteria measured on CT scan improve the prediction of temporary contraindication for kidney transplantation in obese patients compared to BMI alone?
Cohort (n=97)
Do morphometric criteria measured on CT scan improve the prediction of temporary contraindication for kidney transplantation in obese patients compared to BMI alone?
Effect estimate: AUC 0.88 (95% CI 0.78-0.98)
Combining morphometric obesity parameters from CT scans with BMI improves the prediction of temporary contraindication decisions for kidney transplantation in obese patients.
May aid obese kidney transplant candidate selection; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Morbid obesity, based on body mass index (BMI) and/or clinical examination, can be a temporary contraindication (TCI) of kidney transplantation. However, BMI alone does not evaluate the intra- or extra-peritoneal distribution of fatty tissue, and clinical examination alone is subjective. The objective was to evaluate the interest of morphometric criteria to ensure reproducible and consensual decision of TCI. METHODS: We retrospectively included patients with a BMI >30 transplanted or temporarily contraindicated because of their weight from 2012 to 2017. The following measurements were performed on CT scan sections using a semiautomatic Hounsfield density detection software: subcutaneous adipose tissue surface (SAT), visceral adipose tissue surface (VAT), vessel-to-skin distance (VSK), abdominal perimeter (AP), and psoas index. Performance of morphometric measures to predict TCI was assessed through ROC analysis. RESULTS: Ninety-seven patients were included: 76 kidney transplant recipients and 21 on the TCI list. The area under the curve (AUC, 95%CI) for the BMI model to predict TCI was 0.81 (0.72-0.90). A 5-variable model including BMI, VAT, VSK, AP, and age gave an AUC of 0.88 (0.78-0.98). CONCLUSIONS: Morphometric obesity parameters are associated with TCI decision-making for kidney transplantation: When combined with BMI in a "morphometric tool," they were predictive of a TCI decision.
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Pinar et al. (2020) conducted a cohort in Obesity in kidney transplantation candidates (n=97). 5-variable morphometric model (BMI, VAT, VSK, AP, and age) vs. BMI alone was evaluated on Prediction of temporary contraindication (TCI) (AUC 0.88, 95% CI 0.78-0.98). A 5-variable morphometric model including BMI, visceral adipose tissue, vessel-to-skin distance, abdominal perimeter, and age predicted temporary contraindication with an AUC of 0.88.
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