Skip to main content
SpringerLink
Log in

Obesity in pediatric kidney transplant recipients and the risks of acute rejection, graft loss and death

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

Obesity is prevalent in children with chronic kidney disease (CKD), but the health consequences of this combination of comorbidities are uncertain. The aim of this study was to evaluate the impact of obesity on the outcomes of children following kidney transplantation.

Methods

Using data from the ANZDATA Registry (1994–2013), we assessed the association between age-appropriate body mass index (BMI) at the time of transplantation and the subsequent development of acute rejection (within the first 6 months), graft loss and death using adjusted Cox proportional hazards models.

Results

Included in our analysis were 750 children ranging in age from 2 to 18 (median age 12) years with a total of 6597 person-years of follow-up (median follow-up 8.4 years). Overall, at transplantation 129 (17.2%) children were classified as being overweight and 61 (8.1%) as being obese. Of the 750 children, 102 (16.2%) experienced acute rejection within the first 6 months of transplantation, 235 (31.3%) lost their allograft and 53 (7.1%) died. Compared to children with normal BMI, the adjusted hazard ratios (HR) for graft loss in children who were underweight, overweight or diagnosed as obese were 1.05 [95% confidence interval (CI) 0.70–1.60], 1.03 (95% CI 0.71–1.49) and 1.61 (95% CI 1.05–2.47), respectively. There was no statistically significant association between BMI and acute rejection [underweight: HR 1.07, 95% CI 0.54–2.09; overweight: HR 1.42, 95% CI 0.86–2.34; obese: HR 1.83, 95% CI 0.95–3.51) or patient survival (underweight: HR 1.18, 95% CI 0.54–2.58, overweight: HR 0.85, 95% CI 0.38–1.92; obese: HR 0.80, 95% CI 0.25–2.61).

Conclusions

Over 10 years of follow-up, pediatric transplant recipients diagnosed with obesity have a substantially increased risk of allograft failure but not acute rejection of the graft or death.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Australian Institute of Health and Welfare (AIHW) (2015) Cardiovascular disease, diabetes and chronic kidney disease—Australian facts: risk factors (full publication; 11 March 2015 edition). AIHW, pp 1–112. Available at: http://aihw.gov.au/publication-detail/?id=60129550538

  2. Ogden CL, Carroll MD, Kit BK, Flegal KM (2012) Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA 307:483–490

    Article  PubMed  Google Scholar 

  3. Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NME, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang J-C, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DFJ, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SEAH, Kengne AP, Khader YS, Khang Y-H, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KMV, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJC, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang X, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon S-J, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJL, Gakidou E (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013;2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:766–781

    Article  PubMed  PubMed Central  Google Scholar 

  4. Di Bonito P, Sanguigno E, Forziato C, Di Fraia T, Moio N, Cavuto L, Sibilio G, Iardino MR, Di Carluccio C, Capaldo B (2014) Glomerular filtration rate and cardiometabolic risk in an outpatient pediatric population with high prevalence of obesity. Obesity 22:585–589

    Article  PubMed  Google Scholar 

  5. Nguyen S, McCulloch C, Brakeman P, Portale A, C-y H (2008) Being overweight modifies the association between cardiovascular risk factors and microalbuminuria in adolescents. Pediatrics 121:37–45

    Article  PubMed  PubMed Central  Google Scholar 

  6. Plumb LA, Pitcher D, Tse Y, Shield JP, Inward C, Sinha MD, Nephrology OBotBAfP (2014) Longitudinal changes in body mass index following renal transplantation in UK children. Nephrol Dial Transplant 29:196–203

    Article  PubMed  Google Scholar 

  7. Bonthuis M, Van Stralen KJ, Verrina E, Groothoff JW, Alonso Melgar Á, Edefonti A, Fischbach M, Mendes P, Molchanova EA, Paripović D, Peco-Antic A, Printza N, Rees L, Rubik J, Stefanidis CJ, Sinha MD, Zagożdżon I, Jager KJ, Schaefer F (2013) Underweight, overweight and obesity in paediatric dialysis and renal transplant patients. Nephrol Dial Transplant 28 [Suppl 4]: iv195-iv204

  8. Hanevold CD, Ho PL, Talley L, Mitsnefes MM (2005) Obesity and renal transplant outcome: a report of the North American Pediatric Renal Transplant Cooperative Study. Pediatrics 115:352–356

    Article  PubMed  Google Scholar 

  9. Omoloja A, Stolfi A, Mitsnefes M (2005) Pediatric obesity at renal transplantation: a single center experience. Pediatr Transplant 9:770–772

    Article  PubMed  Google Scholar 

  10. Boschetti SB, Nogueira PCK, Pereira AML, Fisberg M, Pestana JOM (2012) Prevalence, risk factors, and consequences of overweight in children and adolescents who underwent renal transplantation—short- and medium-term analysis. Pediatr Transplant 17:41–47

    Article  PubMed  Google Scholar 

  11. Mitsnefes MM, Khoury P, McEnery PT (2002) Body mass index and allograft function in pediatric renal transplantation. Pediatr Nephrol 17:535–539

    Article  PubMed  Google Scholar 

  12. Höcker B, Weber LT, Feneberg R, Drube J, John U, Fehrenbach H, Pohl M, Zimmering M, Fründ S, Klaus G, Wühl E, Tönshoff B (2010) Improved growth and cardiovascular risk after late steroid withdrawal: 2-year results of a prospective, randomised trial in paediatric renal transplantation. Nephrol Dial Transplant 25:617–624

    Article  PubMed  Google Scholar 

  13. Ahmadi S-F, Zahmatkesh G, Streja E, Molnar MZ, Rhee CM, Kovesdy CP, Gillen DL, Steiner S, Kalantar Zadeh K (2014) Body mass index and mortality in kidney transplant recipients: a systematic review and meta-analysis. Am J Nephrol 40:315–324

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nicoletto BB, Fonseca NKO, Manfro RC, Gonçalves LFS, Leitão CB, Souza GC (2014) Effects of obesity on kidney transplantation outcomes: a systematic review and meta-analysis. Transplantation 98:167–176

    Article  PubMed  Google Scholar 

  15. Kuczmarski RJ, Ogden CL, Guo SS (2000) CDC growth charts. Vital and Health Statistics of the Centers for Disease Control and Prevention, National Center for Health Statistics, Atlanta. Available at: https://www.cdc.gov/nchs/products/series/series11.htm (No.246)

  16. Cole TJ, Bellizzi MC, Flegal KM, Dietz WH (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ 320:1240–1243

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Denburg MR, Pradhan M, Shults J, Jones A, Palmer JA, Baluarte HJ, Leonard MB (2010) Longitudinal relations between obesity and hypertension following pediatric renal transplantation. Pediatr Nephrol 25:2129–2139

    Article  PubMed  Google Scholar 

  18. Sorof JM, Sullivan EK, Tejani A, Portman RJ (1999) Antihypertensive medication and renal allograft failure: a North American Pediatric Renal Transplant Cooperative Study report. J Am Soc Nephrol 10:1324–1330

    CAS  PubMed  Google Scholar 

  19. Irtan S, Maisin A, Baudouin V, Nivoche Y, Azoulay R, Jacqz-Aigrain E, El Ghoneimi A, Aigrain Y (2010) Renal transplantation in children: critical analysis of age related surgical complications. Pediatr Transplant 14:512–519

    Article  CAS  PubMed  Google Scholar 

  20. Gore JL, Pham PT, Danovitch GM, Wilkinson AH, Rosenthal JT, Lipshutz GS, Singer JS (2006) Obesity and outcome following renal transplantation. Am J Transplant 6:357–363

    Article  CAS  PubMed  Google Scholar 

  21. Marcen R, Fernández A, Pascual J, Teruel JL, Villafruela JJ, Rodriguez N, Martins J, Burgos FJ, Ortuno J (2007) High body mass index and posttransplant weight gain are not risk factors for kidney graft and patient outcome. Transplantation 39:2205–2207

    CAS  Google Scholar 

  22. Meier-Kriesche H-U, Arndorfer JA, Kaplan B (2002) The impact of body mass index on renal transplant outcomes: a significant independent risk factor for graft failure and patient death. Transplantation 73:70–74

    Article  PubMed  Google Scholar 

  23. Lafranca JA, IJermans JNM, Betjes MGH, Dor FJMF (2015) Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis. BMC Med 13:111

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gray NA, Mahadevan K, Campbell VK, Noble EP, Anstey CM (2013) Data quality of the Australia and New Zealand dialysis and transplant registry: a pilot audit. Nephrology 18:665–670

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Sydney School of Public Health, University of Sydney, Sydney, Australia

    Maleeka Ladhani, Louise A. Baur, Jonathan C. Craig & Germaine Wong

  2. Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, NSW, 2145, Australia

    Maleeka Ladhani, Jonathan C. Craig & Germaine Wong

  3. Department of General Medicine, The Children’s Hospital at Westmead, Westmead, Australia

    Samantha Lade

  4. The Children’s Hospital at Westmead Clinical School, University of Sydney, Sydney, Australia

    Stephen I. Alexander & Louise A. Baur

  5. ANZDATA Registry SA, Health & Medical Research Institute, Adelaide & Faculty of Health Sciences, University of Adelaide, Adelaide, Australia

    Philip A. Clayton & Stephen McDonald

  6. Centre for Renal and Transplant Research, Westmead Hospital, Westmead, NSW, Australia

    Germaine Wong

Authors
  1. Maleeka Ladhani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samantha Lade
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stephen I. Alexander
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Louise A. Baur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Philip A. Clayton
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephen McDonald
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jonathan C. Craig
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Germaine Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maleeka Ladhani.

Ethics declarations

Disclosures

The authors declare that they have no conflicts of interest.

Funding

ML is the recipient of an NHMRC Postgraduate Scholarships Grant: Clinical Postgraduate Research Scholarship APP1074409.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 82.9 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ladhani, M., Lade, S., Alexander, S.I. et al. Obesity in pediatric kidney transplant recipients and the risks of acute rejection, graft loss and death. Pediatr Nephrol 32, 1443–1450 (2017). https://doi.org/10.1007/s00467-017-3636-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-017-3636-1

Keywords

Search

Navigation