Affiliation:
1. University of Rochester School of Medicine Rochester New York USA
2. University of Washington Medical Center Seattle Washington USA
3. Department of Urologic Sciences University of British Columbia Vancouver BC Canada
4. Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston Salem North Carolina USA
5. Department of Internal Medicine Section of Nephrology Atrium Health Wake Forest Baptist Winston Salem North Carolina USA
Abstract
AbstractIntroductionMany kidney transplant (KT) centers decline patients with a body mass index (BMI) ≥40 kg/m2. This study's aim was to evaluate KT outcomes according to recipient BMI.MethodsWe performed a single‐center, retrospective review of adult KTs comparing BMI ≥40 patients (n = 84, BMI = 42 ± 2 kg/m2) to a matched BMI < 40 cohort (n = 84, BMI = 28 ± 5 kg/m2). Patients were matched for age, gender, race, diabetes, and donor type.ResultsBMI ≥40 patients were on dialysis longer (5.2 ± 3.2 years vs. 4.1 ± 3.5 years, p = .03) and received lower kidney donor profile index (KDPI) kidneys (40 ± 25% vs. 53 ± 26%, p = .003). There were no significant differences in prevalence of delayed graft function, reoperations, readmissions, wound complications, patient survival, or renal function at 1 year. Long‐term graft survival was higher for BMI ≥40 patients, including after adjusting for KDPI (BMI ≥40: aHR = 1.79, 95% CI = 1.09–2.9). BMI ≥40 patients had similar BMI change in the first year post‐transplant (delta BMI: BMI ≥ 40 +.9 ± 3.3 vs. BMI < 40 +1.1 ± 3.2, p = .59).ConclusionsOverall outcomes after KT were comparable in BMI ≥40 patients compared to a matched cohort with lower BMI with improved long‐term graft survival in obese patients. BMI‐based exclusion criteria for KT should be reexamined in favor of a more individualized approach.
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