Lifestyle Changes Are Key to Kidney Transplant Health Outcomes – Everyday Health
Risk factors such as cancer and heart disease point to new approaches in treatment.
Improving patients’ weight, eating habits, exercise, and overall health pre- and post-transplantation may improve their outcomes.
Organ rejection is the single biggest concern for kidney transplant patients, but new research suggests that cancer, infections, and heart disease may pose greater threats to long-term survival. As a result, lifestyle changes are a major factor in determining patients’ outcomes.
The findings, published in the February issue of the journal Transplantation Direct, suggest there are two types of kidney transplant patients — younger, nondiabetic patients who develop kidney failure due to organ rejection, and older, often diabetic patients who are at risk of dying of complications stemming from their health.
Instead of a standardized, one-size-fits-all approach to treating these patients, the study’s lead author is recommending that doctors take stock of each person’s individual health and risk profile.
Improving patients’ weight, eating habits, exercise, and overall health pre- and post-transplantation may improve their outcomes.
“Even though people look to kidney transplants as their saving grace, making changes to your health is really important for long-term benefit,” says the study's lead coauthor Andrew J. Bentall, MBChB, MD, a nephrologist at the Mayo Clinic in Rochester, Minnesota.
For his study, Dr. Bentall looked at 5,752 patients who underwent a kidney transplant at Mayo Clinic sites in Arizona, Florida, or Minnesota between 2006 and 2018. During this time period, 691 patients died with a functioning kidney — 20 percent of cancer, 19.7 percent of infections, and 12.6 percent of heart disease. Another 553 patients lost their transplant because the transplanted kidney failed — 38.7 percent of these patients’ kidneys failed due to rejection.
Bentall says that studies so far typically focus on transplant success rates and types of kidney rejection, but his is the largest to date and provides the most detailed look at why patients die with a functioning kidney.
Right now, standardized care is built around a regimen of immunosuppressive medications that patients take daily to lower the risk of organ rejection. Ninety-nine percent of kidney transplants are successful at the one-year mark — a massive improvement compared with the rate of about 30 to 50 percent 30 years ago, before antirejection medications were developed, Bentall says.
But these medications come with a string of complications, including high blood pressure, weight gain, and an increased risk of infections and some forms of cancer, according to the National Kidney Foundation.
Bear in mind that the National Institute of Diabetes and Digestive and Kidney Diseases says the two most common causes of kidney disease in Americans are diabetes and high blood pressure, which means patients often are already grappling with these chronic conditions.
Bentall found that age 55 is the demarcation between younger and older transplant patients. Younger patients faced higher risk of kidney rejection and could benefit from an increased immunosuppressive drug regimen. Older patients were at risk of dying of cancer or urinary tract, lung, and viral infections, and could benefit from lower levels of immunosuppressive drugs.
“Peoples’ immune systems get weaker as they age, and they’re on immunosuppressants, increasing the risk of infections older people have trouble fighting off,” Bentall says.
Older patients also need care that highlights lifestyle changes that address obesity, high blood pressure, and diabetes, whether these were chronic conditions patients had pre-transplantation or not.
Bentall says he hopes the research will usher in a personalized approach that treats these two populations differently.
“It’s important in medicine to make decisions based on data rather than intuition. Figures and numbers help to tell patients, ‘We looked at patients like you and you are more likely to have problems in these areas, but we can make these specific changes to improve your outcomes,’” he says.
“The key message is to talk to your physician to ask for the best immunosuppressive treatment options for you [as you go] into transplant and how you can change your medical risk profile to try to have an excellent outcome,” Bentall says.
The research should be used as a “springboard” for frontline physicians tending to kidney transplant recipients, according to Hannah Kerr, MD, a kidney and pancreas transplant surgeon at the Cleveland Clinic in Ohio.
“I definitely agree that perhaps immunosuppression could more generally be reduced in older patients,” she says. “We spend a lot of time monitoring for complications of the antirejection medications.”
Dr. Kerr says patients must pass a pre-transplant examination that includes weight and overall health, but there should be an “even stronger focus” on these factors post-transplant as they adjust to drugs that come with strong side effects.
Fasika M. Tedla, MD, a nephrologist and the medical director of kidney transplantation at the Recanati/Miller Transplantation Institute at Mount Sinai Medical Center in New York City says the findings are “valuable,” and that they validate trends that specialists have seen in their practices with concrete data.
He says immunosuppressive medications are the “holy grail” of transplantation, but the transplant community has been trying to better understand how to adjust the intensity of therapies to suit each patient.
“It brings to light the same age-old question of how to individualize immunosuppression. It’s a tricky balance — we have to rely on what we know from existing trials, and we have to follow up with patients and adjust accordingly,” Dr. Tedla says.
Even in the face of guesswork and real-time tweaking, Tedla says the field has come a long way.
“I would tell patients and their families that the overall trajectory of outcomes in patients who receive kidney transplants has only improved despite the limitations. It’s clear that patients’ health, quality of life and survival is better with a kidney transplant than with dialysis,” he says.
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