Impacto do estado nutricional pré-transplante nos desfechos clínicos, sobrevida do enxerto e risco de morte em pacientes transplantados renais

Abstract

Introduction: Chronic kidney disease is currently considered a health problem worldwide and protein-energy malnutrition in these patients is frequent and an important predictor of morbidity and mortality. Kidney transplantation can improve patient's quality of life and survival, but complications after the procedure are still significant and may be associated with the recipient's nutritional status. Little consideration is given to nutrition in the preparation phase and in kidney transplant surgery and, therefore, the prevalence of malnourished patients before and after transplantation and the influence of the nutritional status on results after the procedure are still underestimated. Objectives: To assess the impact of the nutritional status in recipients before kidney transplantation on renal function, clinical outcomes, graft survival and risk of death. Material and Methods: In this retrospective cohort study including 451 transplanted patients between 2008 and 2018, at University Hospital of The Faculty of Medical Sciences, an easy to use nutritional screening tool was developed for patients in preparation for kidney transplantation, based on anthropometric, laboratory and clinical data. For this, a risk score was elaborated with these data. The sum of all components of the score varies from 0 to 12 points. The patients were stratified into three groups, according to the final score: G1 (0 to 2 points) = low risk; G2 (2-4 points) = moderate risk and G3 (> 5 points) = high risk of malnutrition. Results: Stratifying the 451 patients based on the pre-transplant risk score, G1 was composed of 90, G2 of 292 and G3 of 69 patients. G1 patients maintained the lowest creatinine levels at the time of hospital discharge after transplantation, when compared to the other two groups (p = 0.012). Transplant recipients from G3 had a higher proportion of graft losses, with the mean graft survival time in months being 100.56 + 46.49 in G1, 94.64 + 54.34 in G2 and 77.76 +49.01 in G3 (p = 0.044). The Kaplan-Meier survival curve showed better survival for patients in G1, when compared to the other groups (p = 0.046). G3 patients had almost three times greater risk of graft loss (Hazard Ratio [HR] 2.94; 95% CI; 1.084-7.996). Sensitized patients and patients with delayed graft function had almost twice the risk (HR 1,904, 95% CI 1,168-3,105; HR 1,921, 95% CI 1,238-2,980) and patients with cellular rejection or humoral rejection had a 2.18 times greater risk (HR 2,180, 95% CI 1,251-3,798) of graft loss. Conclusion: Kidney transplant patients with a higher risk of malnutrition according to the pre transplant score were associated with worse outcomes and graft survival. The nutritional screening tool is easy to be used in clinical practice to evaluate the patient in preparation for kidney transplant.