Absence of the Effect of Pretransplant Body Mass Index on Post Kidney Transplant Outcomes

Prog Transplant. 2016 Jun;26(2):183-90. doi: 10.1177/1526924816640679. Epub 2016 Apr 21.

Abstract

Context: Obesity has been reported as risk factor for reduced posttransplant graft and patient survival and increased delayed graft function (DGF).

Objective: The purpose of this work is to analyze the effect of body mass index (BMI) on defined transplant outcomes in patients transplanted under defined guidelines in a kidney transplant program.

Design: Review of a prospectively collected database in renal transplant recipients receiving rabbit antithymocyte globulin induction, mycophenolate mofetil, tacrolimus, and early corticosteroid withdrawal between 2001 and 2011.

Setting: This review was conducted in a single abdominal transplant program in the United States.

Main outcome measures: Primary outcome was death-censored graft survival categorized by posttransplant body mass groups. Secondary outcomes included DGF as well as patient survival.

Results: Four hundred sixty seven patients were identified. No difference was observed in graft survival or DGF between BMI groups. One-year, death-censored graft survival and patient survival rates ranged from 97.5% to 100% and 96.6% to 100%, respectively. Delayed graft function was uncommon across all BMI groups, ranging from 5.3% to 9.1%, with the lowest incidence in patients with a BMI ≥ 35 kg/m(2). Biopsy-proven acute rejection rates at 1 year were similar across all groups (10.1%-14%) as were estimated glomerular filtration rates were at 1, 3, and 5 years.

Conclusion: Our results do not show an effect of BMI on posttransplant outcomes, suggesting that relaxation of BMI criteria may be warranted for recipient selection.

Keywords: complications; delayed graft function; live donors; obesity; outcome; rejection.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Adult
  • Aged
  • Antilymphocyte Serum / therapeutic use
  • Body Mass Index
  • Comorbidity
  • Databases, Factual
  • Delayed Graft Function / epidemiology*
  • Female
  • Glomerular Filtration Rate
  • Graft Rejection / epidemiology*
  • Graft Rejection / prevention & control
  • Graft Survival
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation
  • Male
  • Middle Aged
  • Mycophenolic Acid / analogs & derivatives
  • Mycophenolic Acid / therapeutic use
  • Obesity / epidemiology*
  • Overweight / epidemiology
  • Retrospective Studies
  • Survival Rate
  • Tacrolimus / therapeutic use
  • Thinness / epidemiology*
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Antilymphocyte Serum
  • Immunosuppressive Agents
  • Mycophenolic Acid
  • Tacrolimus