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Increased Recipient Body Mass Index Is Associated With Acute Rejection and Other Adverse Outcomes After Kidney Transplantation

Curran, Simon P.1; Famure, Olusegun1; Li, Yanhong1; Kim, S. Joseph1,2,3

doi: 10.1097/TP.0b013e3182a688a4
Clinical and Translational Research

Background: Outcomes of kidney transplant recipients with increased body mass index (BMI) remain controversial. We studied the relationship between BMI and clinically relevant outcomes among kidney transplant recipients at a large center.

Methods: We performed an observational cohort study of all recipients of kidney transplants at our center from January 1, 2000 to December 31, 2010 to determine if increased BMI at transplantation is associated with adverse outcomes, including delayed graft function and biopsy-proven acute rejection (BPAR). Recipient BMI was categorized as <20, 20 to 24.9 (reference), 25 to 29.9, 30 to 34.9, and ≥35 kg/m2. Potential confounders were included in logistic and Cox proportional hazards models.

Results: A total of 1151 patients were studied. Recipient BMI of 30 to 34.9 and ≥35 kg/m2 were associated with an increased risk of delayed graft function (odds ratio [95% confidence interval [CI], 1.92 [1.16–3.19] and 4.49 [2.24–9.00], respectively). BMI≥35 kg/m2 was also associated with an increased risk of BPAR (hazard ratio [HR; 95% CI], 2.43 [1.48–3.99]), all-cause graft failure (HR [95% CI], 1.97 [1.09–3.56]), and death-censored graft failure (HR [95% CI], 2.43 [1.07–5.51]). Adjustment for acute rejection as a time-varying covariate significantly attenuated the association with graft failure endpoints. There was no significant relation between BMI and death with graft function.

Conclusions: Increased BMI at kidney transplantation is a predictor of adverse outcomes, including BPAR. The role of pretransplantation weight reduction in improving graft and patient outcomes requires further study.

1 Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.

2 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

3 Address correspondence to: S. Joseph Kim, M.D., Ph.D., M.H.S., F.R.C.P.C., Division of Nephrology and the Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue, 11C-1183, Toronto, Ontario, Canada M5G 2N2.

The authors declare no funding or conflicts of interest.

E-mail: joseph.kim@uhn.ca

S.P.C., O.F., and S.J.K. participated in the study concept and design. O.F. and S.J.K. participated in the acquisition of data. S.P.C., O.F., Y.L., and S.J.K. participated in the analysis and interpretation of data and critical revision of the article. S.P.C., Y.L., and S.J.K. participated in the drafting of the article. Y.L. and S.J.K. participated in the statistical analysis. S.J.K. participated in the administrative, technical, or material support and study supervision.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Received 17 December 2012. Revision requested 6 January 2013.

Accepted 23 July 2013.

Accepted September 20, 2013

© 2014 by Lippincott Williams & Wilkins