Kalathil K Sureshkumar1, Bhavna Chopra1, Michelle A Josephson2, Pratik B Shah3, Rita L McGill4. 1. Division of Nephrology and Hypertension, Department of Medicine, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA. 2. Section of Nephrology, Department of Medicine, University of Chicago, IL. 3. Division of Nephrology, University of California at Davis, Sacramento, CA. 4. Section of Nephrology, Department of Medicine, University of Chicago, IL. Electronic address: rmcgill1@medicine.bsd.uchicago.edu.
Abstract
RATIONALE & OBJECTIVE: The impact of extreme recipient obesity on long-term kidney transplant outcomes has been controversial. This study sought to evaluate the association of various levels of recipient obesity on kidney transplantation outcomes by comparing mate-kidney recipient pairs to address possible confounding effects of donor characteristics on post-transplant outcomes. DESIGN: Nationwide observational cohort study, using mate-kidney models. SETTING & PARTICIPANTS: Analysis based on the Organ Procurement and Transplant Network/United Network of Organ Sharing database. 44,560 adult recipients of first-time deceased donor kidney transplants from 2001-2016, paired by donor. PREDICTORS: Recipient body mass index (BMI) was categorized: 18-25 (n=12,446), >25-30 (n=15,477), >30-35 (n=11,144) (obese) and >35 kg/m2 (n=5,493) (extreme obesity). MEASURE: ments: Outcomes included patient survival, graft survival, death-censored graft survival, delayed graft function and length of stay. ANALYTICAL APPROACH: Conditional logistic regression and stratified proportional hazards models were used to compare outcomes as odds ratios (OR) and hazard ratios (HR), adjusted for recipient and transplant factors, using recipients with BMI>35 as a reference. RESULTS: At a median follow-up of 3.9 years, adjusted OR for delayed graft function were 0.42 [95% CI 0.36-0.48], 0.55 [95% CI 0.48-0.62], 0.73 [95% CI 0.64-0.83] for BMI 18-25, >25-30, and >30-35 respectively, P<0.001 for all. Death-censored graft failure was lower for BMI ≤25 (HR 0.66, [95% CI 0.59 -0.74] and BMI >25-30 (HR 0.79, [95% CI 0.70-0.88], P<0.001 for both, but not BMI >30-35 [HR 0.91, 95% CI 0.861-1.02, P=0.09]. Length of stay and patient survival did not differ by recipient BMI. LIMITATIONS: Observational study with limited detail regarding potential confounders. CONCLUSIONS: Despite an increased risk of delayed graft function likely unrelated to donor organ quality, long-term transplant outcomes among recipients with BMI>35 are similar to those among recipients with BMI >30-35, supporting a flexible approach to kidney transplantation candidacy in candidates with extreme obesity.
RATIONALE & OBJECTIVE: The impact of extreme recipient obesity on long-term kidney transplant outcomes has been controversial. This study sought to evaluate the association of various levels of recipient obesity on kidney transplantation outcomes by comparing mate-kidney recipient pairs to address possible confounding effects of donor characteristics on post-transplant outcomes. DESIGN: Nationwide observational cohort study, using mate-kidney models. SETTING & PARTICIPANTS: Analysis based on the Organ Procurement and Transplant Network/United Network of Organ Sharing database. 44,560 adult recipients of first-time deceased donor kidney transplants from 2001-2016, paired by donor. PREDICTORS: Recipient body mass index (BMI) was categorized: 18-25 (n=12,446), >25-30 (n=15,477), >30-35 (n=11,144) (obese) and >35 kg/m2 (n=5,493) (extreme obesity). MEASURE: ments: Outcomes included patient survival, graft survival, death-censored graft survival, delayed graft function and length of stay. ANALYTICAL APPROACH: Conditional logistic regression and stratified proportional hazards models were used to compare outcomes as odds ratios (OR) and hazard ratios (HR), adjusted for recipient and transplant factors, using recipients with BMI>35 as a reference. RESULTS: At a median follow-up of 3.9 years, adjusted OR for delayed graft function were 0.42 [95% CI 0.36-0.48], 0.55 [95% CI 0.48-0.62], 0.73 [95% CI 0.64-0.83] for BMI 18-25, >25-30, and >30-35 respectively, P<0.001 for all. Death-censored graft failure was lower for BMI ≤25 (HR 0.66, [95% CI 0.59 -0.74] and BMI >25-30 (HR 0.79, [95% CI 0.70-0.88], P<0.001 for both, but not BMI >30-35 [HR 0.91, 95% CI 0.861-1.02, P=0.09]. Length of stay and patient survival did not differ by recipient BMI. LIMITATIONS: Observational study with limited detail regarding potential confounders. CONCLUSIONS: Despite an increased risk of delayed graft function likely unrelated to donor organ quality, long-term transplant outcomes among recipients with BMI>35 are similar to those among recipients with BMI >30-35, supporting a flexible approach to kidney transplantation candidacy in candidates with extreme obesity.
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