Morbid obesity does not preclude successful renal transplantation

Abstract

Many renal transplantation centers arbitrarily deny transplantation to patients with morbid obesity usually defined as body mass index > 35. We present a series of 173 primary renal transplant patients in a new transplant program that accepted all recipients with 3 yrs or greater life expectancy and no active malignancy or infection. When the patient outcomes are divided into groups by body mass index, it can be seen as expected that patients with body mass index > 30 have an increased prevalence of wound infections (p < 0.05). However, aside from this complication there are no statistically significant outcome differences between the three groups realizing the possibility of type II statistical error because of small numbers. Graft survival, patient survival and other surgical complications are the same in all groups regardless of body mass index. At the end of the 3-yr interval with a minimum transplant follow-up of 3 months, 169 of 173 patients were alive and 163 of 173 transplants were functioning. Based on our experience, morbid obesity should not be used to exclude patients arbitrarily from transplantation anymore than advanced age or diabetes should.

Body Mass Index, Waist Circumference and Mortality in Kidney Transplant Recipients

“…In a seemingly paradoxical manner higher BMI has been associated with better survival in various chronic disease states (8)(9)(10) and also in ESRD (11)(12)(13)(14)(15)(16)(17)(18) and in nondialysis dependent CKD (19). Due to observations suggesting short-term poor outcomes (20-23) related to cardiovascular, infectious and metabolic complications (24)(25)(26)(27)(28)(29) in patients with higher BMI in the immediate posttransplant period obesity as defined by elevated BMI is in general deemed undesirable in kidney transplant recipients. Furthermore, it is currently not recommended for patients deemed extremely obese (BMI > 35 kg/m 2 ) to undergo kidney transplantation (39) unless they are able to loose weight (40).…”

“…Studies about the effects of obesity on outcomes in kidney transplant recipients are relatively scarce. Higher BMI has been associated with short-term adverse outcomes after kidney transplantation (20)(21)(22)(23), likely as a result of cardiovascular, infectious and metabolic complications (24)(25)(26)(27)(28)(29). The long-term outcomes associated with obesity in kidney transplant recipients are not that well characterized.…”

Nondiabetic consequences of obesity on kidney

“…Obesity has traditionally been believed to have a negative outcome on renal transplantation, and many centers will deny transplantation for patients with BMI >35 kg/m 2 [58]. Recently, two adult centers have reported the outcome of renal transplantation in morbidly obese individuals [59,60]. Obese transplant recipients with BMI >35 kg/m 2 had similar graft and patient survival rates to nonobese individuals with BMI <25 kg/m 2 [59].…”

Obesity and Kidney Transplantation

“…Delayed graft function (DGF), defined as the need for dialysis therapy in the first week after kidney transplantation, places a recipient at increased risk for chronic rejection and decreased graft survival. Only a minority of single-center studies have shown that obesity increases risk for decreased graft survival after kidney transplantation (46)(47)(48)(49)(50)(51)(52)(53) but this may be due to small sample sizes in these single-center studies. In a large study which included 51,927 kidney transplant recipients, severe obesity (BMI > 35 kg/m 2 ) was associated with a 51% increased risk of DGF compared to the transplant recipients with a BMI between 22-24 kg/m 2 (41).…”

“…Overall mortality, regardless of obesity status, is substantially reduced with kidney transplantation (43,44). However, compared to non-obese kidney transplant recipients, obese transplant recipients appear to have an increased risk of graft loss although not all studies agree (39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56) (40,41). The magnitude of the association between morbid obesity and graft failure is similar to the increased risk of graft failure associated with diabetes (40).…”