The survival benefit of kidney transplantation in obese patients

Am J Transplant. 2013 Aug;13(8):2083-90. doi: 10.1111/ajt.12331.

Abstract

Obese patients have a decreased risk of death on dialysis but an increased risk of death after transplantation, and may derive a lower survival benefit from transplantation. Using data from the United States between 1995 and 2007 and multivariate non-proportional hazards analyses we determined the relative risk of death in transplant recipients grouped by body mass index (BMI) compared to wait-listed candidates with the same BMI (n = 208 498). One year after transplantation the survival benefit of transplantation varied by BMI: Standard criteria donor transplantation was associated with a 48% reduction in the risk of death in patients with BMI ≥ 40 kg/m(2) but a ≥ 66% reduction in patients with BMI < 40 kg/m2. Living donor transplantation was associated with ≥ 66% reduction in the risk of death in all BMI groups. In sub-group analyses, transplantation from any donor source was associated with a survival benefit in obese patients ≥ 50 years, and diabetic patients, but a survival benefit was not demonstrated in Black patients with BMI ≥ 40 kg/m(2). Although most obese patients selected for transplantation derive a survival benefit, the benefit is lower when BMI is ≥ 40 kg/m(2), and uncertain in Black patients with BMI ≥ 40 kg/m(2).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • African Continental Ancestry Group / statistics & numerical data
  • Body Mass Index
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Graft Rejection / etiology*
  • Humans
  • Kidney Failure, Chronic / mortality*
  • Kidney Transplantation / mortality*
  • Living Donors
  • Male
  • Middle Aged
  • Obesity / complications*
  • Obesity / mortality
  • Survival Rate