• Logo
  • SBMUJournals

Effect of Visceral, Subcutaneous and Retroperitoneal Adipose Tissue on Renal Function After Living Donor Nephrectomy: A Retrospective Analysis of 69 Cases

Murat Ferhat Ferhatoglu, Eray Atli, Alp Gurkan



Purpose: Recent studies reported that the presence of metabolic syndrome is closely correlated with impaired kidney function after living donor nephrectomy. Since the measurement of body mass index cannot differentiate the amount of body adipose tissue from total body weight, body mass index is not a reliable or enough alone parameter for determining metabolic syndrome. In the present study, we investigated the correlation between body adipose tissue and kidney function recovery following living donor nephrectomy procedure.

Materials and Methods: The patients who underwent living kidney donor nephrectomy consequently from July 2016 through December 2017 were enrolled in the study. A preoperative computed tomography scan measured the visceral (VAdT), retroperitoneal (RPAdT), and subcutaneous (SCAdT) adipose tissue volume. Body mass index, adipose tissue measurements were analyzed according to a postoperative estimated glomerular filtration rate (eGFR).

Results: The decrease between preoperative eGFR, and the first day, the first month and the sixth month eGFR after surgery was statistically significant (p = .001; p = .001; p = .001, respectively). The negative correlation between VAdT/SCAdT measurements and changes in eGFR at the first and the sixth postoperative month compared to preoperative eGFR were found to be statistically significant (p = .049; p = .041, respectively). Additionally, RPAdT measurements and changes in eGFR at the first and the sixth postoperative month compared to preoperative eGFR (decreasing as RPAdT value increased) were found to be statistically significant (p = .035; p = .026, respectively).

Conclusion: According to a preoperative computed tomography scan, VAdT, RPAdT, and VAdT-to-SAdT ratio can predict impaired kidney function recovery. Furthermore, RPAdT measurement is a new variable to predict the impaired kidney function after donor nephrectomy at a postoperative six months in living kidney donors. 


Adipose tissue; metabolic syndrome; donor; kidney; retroperitoneal; visceral


- Lee HH, Kang SK, Yoon YE, et al. Impact of the Ration of Visceral to Subcutaneous Adipose Tissue in Donor Nephrectomy Patients. Transplant Proc. 2017;49:940–943. Doi: 10.1016/j.transproceed.2017.03.039

- Muzaale AD, Massie AB, Wang MC, et al. Risk of end-stage renal disease following live kidney donation. JAMA 2014;311: 579–586. Doi: 10.1001/jama.2013.285141

- Hori S, Miyake M, Morizawa Y, et al. Impact of Preoperative Abdominal Visceral Adipose Tissue Area and Nutritional Status on Renal Function After Donor Nephrectomy in Japanese Living Donors for Renal Transplantation. Ann Transplant. 2018;23:364–376. Doi: 10.12659/AOT.908625

- Yoon YE, Choi KH, Lee KS, et al. Impact of metabolic syndrome on postdonation renal function in living kidney donors. Transplant Proc. 2015;47:290–294. Doi: 10.1016/j.transproceed.2014.10.051.

- Stenvinkel P, Zoccali C, Ikizler TA. Obesity in CKD – what should nephrologists know? J Am Soc Nephrol. 2013;24:1727–1736. Doi: 10.1681/ASN.2013040330

- Kuwahara K, Uehara A, Yamamoto M, et al. Current status of health among workers in Japan: Results from the Japan Epidemiology Collaboration on Occupational Health Study. Ind Health. 2016;54:505–514. Doi: 10.2486/indhealth.2016-0082

- British Transplantation Society. Guidelines for Living Donor Kidney Transplantation. Fourth Ed. Jan 2018

- Sawinski D, Locke JE. Evaluation of Kidney Donors: Core Curriculum 2018. Am J Kidney Dis. 2018;71: 737–747. Doi: 10.1053/j.ajkd.2017.10.018

- Lentine KL, Vella J. (2018). Evaluation of the living kidney donor candidate. In Brennan DJ (Ed.) UpToDate. Retrieved August 1, 2019, from https://www.uptodate.com/contents/evaluation of-the-living-kidney-donor-candidate

- Bae S, Massie AB, Luo X, et al. Changes in discard rate after the introduction of the Kidney Donor Profile Index (KDPI). Am J Transplant. 2016;16:2202–2207. Doi: 10.1111/ajt.13769

- Masajtis-Zagajewska A, Muras K, Nowicki M. Effects of a Structured Physical Activity Program on Habitual Physical Activity and Body Composition in Patients With Chronic Kidney Disease and in Kidney Transplant Recipients. Exp Clin Transplant. 2019;17:155–164. Doi: 10.6002/ect.2017.0305

- Choi KH, Yang SC, Lee SR, et al. Standardized video- assisted retroperitoneal minilaparotomy surgery for 615 living donor nephrectomies. Transpl Int 2011;24:973–983. Doi: 10.1111/j.1432-2277.2011.01295.x

- Choi KH, Yang SC, Joo DJ, et al. Clinical assessment of renal function stabilization after living donor nephrectomy. Transplant Proc. 2012;44:2906–2909. Doi: 10.1016/j.transproceed.2012.05.086

- U.S. Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/communication-programs/nkdep/laboratory-evaluation/glomerular-filtration-rate/estimating#the-mdrd-equation

- Mosteller RD. Simplified calculation of body-surface area. N Engl J Med. 1987;317:1098.

- Evans, JD. Straightforward statistics for the behavioral sciences. Pacific Grove, CA: Brooks/Cole Publishing; 1996.

- Ohashi Y, Thomas G, Nurko S, et al. Association of meta- bolic syndrome with kidney function and histology in living kidney donors. Am J Transplant. 2013;13:2342–2351. Doi: 10.1111/ajt.12369

- Yoon YE, Choi KH, Lee KS, et al. Impact of metabolic syndrome on postdonation renal function in living kidney donors. Transplant Proc. 2015;47:290–294. Doi: 10.1016/j.transproceed.2014.10.051

- Ersoz F, Erbil Y, Sari S, et al. Predictive Value of Retroperitoneal Fat Area Measurement for Detecting Metabolic Syndrome in Patients Undergoing Adrenalectomy. World J Surg. 2011;35:986–994. Doi: 10.1007/s00268-011-1012-z

- Kim S, Cho B, Lee H, et al. Distribution of abdominal visceral and subcutaneous adipose tissue and metabolic syndrome in a Korean population. Diabetes Care 2011;34:504–506. Doi: 10.2337/dc10-1364

- Hung CS, Lee JK, Yang CY, et al. Measurement of Visceral Fat: Should We Include Retroperitoneal Fat. PLOS One 2014;9:112355. Doi: 10.1371/journal.pone.0112355

- Cejkova S, Kubatova H, Thieme F, et al. The effect of cytokines produced by human adipose tissue on monocyte adhesion to the endothelium. Cell Adh Migr. 2019;13:293–302. Doi:10.1080/19336918.2019.1644856

- Jurrissen TJ, Grunewald ZI, Woodford ML, et al. Overproduction of endothelin-1 impairs glucose tolerance but does not promote visceral adipose tissue inflammation or limit metabolic adaptations to exercise. Am J Physiol Endocrinol Metab. 2019 Jul 16. Doi: 10.1152/ajpendo.00178.2019 [Epub ahead of print]

- Eder P, Adler M, Dobrowolska A, Kamhieh-Milz J, Witowski J. The Role of Adipose Tissue in the Pathogenesis and Therapeutic Outcomes of Inflammatory Bowel Disease. Cells. 2019;8:628. Doi: 10.3390/cells8060628

- Naya Y, Zenbutsu S, Araki K, et al. Influence of visceral obesity on oncologic outcome in patients with renal cell carcinoma. Urol Int 2010;85:30–36. Doi: 10.1159/000318988

- Yoshii H, Lam TK, Gupta N, et al. Effects of portal free fatty acid elevation on insulin clearance and hepatic glucose flux. Am J Physiol Endocrinol Metab. 2006;290:1089–1097. Doi: 10.1152/ajpendo.00306.2005

- Kabir M, Catalano KJ, Ananthnarayan S, et al. Molecular evidence supporting the portal theory: a causative link between visceral adiposity and hepatic insulin resistance. Am J Physiol Endocrinol Metab. 2005;288: 454–461. Doi: 10.1152/ajpendo.00203.2004

- Cornier MA, Despres JP, Davis N, et al. Assessing adiposity: a scientific statement from the American Heart Association. Circulation 2011;124:1996–2019. Doi: 10.1161/CIR.0b013e318233bc6a

- Villarroya F, Cereijo R, Gavalda-Navarro A, Villarroya J, Giralt M. Inflammation of brown/beige adipose tissues in obesity and metabolic disease. J Int Med. 2018;284: 492–504. Doi: 10.1111/joim.12803

- Hamaguchi Y, Kaido T, Okumura S, et al. Impact of Skeletal Muscle Mass Index, Intramuscular Adipose Tissue Content, and Visceral to Subcutaneous Adipose Tissue Area Ratio on Early Mortality of Living Donor Liver Transplantation. Transplantation. 2017;101:565–574. Doi: 10.1097/TP.0000000000001587

- Schlecht I, Fischer B, Behrens G, Leitzmann MF. Relations of Visceral and Abdominal Subcutaneous Adipose Tissue, Body Mass Index, and Waist Circumference to Serum Concentrations of Parameters of Chronic Inflammation. Obes Facts. 2016;9:144–157. Doi: 10.1159/000443691

- Delgado C, Chertow GM, Kaysen GA, et al. Associations of Body Mass Index and Body Fat With Markers of Inflammation and Nutrition Among Patients Receiving Hemodialysis. Am J Kidney Dis. 2017;70:817–825. Doi: 10.1053/j.ajkd.2017.06.028

- Ghigliotti G, Barisione C, Garibaldi S, et al. Adipose tissue immune response: novel triggers and consequences for chronic inflammatory conditions. Inflammation. 2014;37:1337–1353. Doi: 10.1007/s10753-014-9914-1

DOI: http://dx.doi.org/10.22037/uj.v0i0.5558


  • There are currently no refbacks.