Obesity by itself is not associated with worse renal transplant outcomes, Australian investigators recently concluded.
Sean H. Chang, MD, of the Queen Elizabeth Hospital in Woodville South, and his collaborators obtained data on 5,684 renal transplant recipients from the Australian and New Zealand Dialysis and Transplant Registry. Obese patients (BMI 30 kg/m2) had significantly worse graft and patient survival than normal-weight patients (BMI 18.5-24.9 kg/m2), but this association disappeared after adjusting for important potential confounders such as diabetes and smoking status and recipient age, gender, and race.
Underweight patients (BMI <18.5 kg/m2), however, had significantly worse late graft survival. More than five years post-transplant, underweight patients had a 70% increased risk of graft loss and an 89% increased risk of death-censored graft loss compared with normal-weight patients. This increased risk was due mainly to chronic allograft nephropathy, the investigators reported.
“Our study suggests that obesity per se should not be a contraindication for kidney transplantation,” the researchers concluded. “However, obese patients had higher unadjusted risks for death, due to its association with other risk factors. Careful pretransplant screening and management are therefore required.”