Pediatric Nephrology

, Volume 32, Issue 8, pp 1443–1450

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

  • Maleeka Ladhani
  • Samantha Lade
  • Stephen I. Alexander
  • Louise A. Baur
  • Philip A. Clayton
  • Stephen McDonald
  • Jonathan C. Craig
  • Germaine Wong
Original Article

DOI: 10.1007/s00467-017-3636-1

Cite this article as:
Ladhani, M., Lade, S., Alexander, S.I. et al. Pediatr Nephrol (2017) 32: 1443. doi:10.1007/s00467-017-3636-1



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.


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.


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).


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.


Acute rejection Body mass index Graft survival Kidney transplantation Obesity Pediatrics 

Supplementary material

467_2017_3636_MOESM1_ESM.docx (83 kb)
ESM 1(DOCX 82.9 kb)

Funding information

Funder NameGrant NumberFunding Note
National Health and Medical Research Council
  • Clinical Postgraduate Research Scholarship APP1074409

Copyright information

© IPNA 2017

Authors and Affiliations

  1. 1.Sydney School of Public HealthUniversity of SydneySydneyAustralia
  2. 2.Centre for Kidney ResearchThe Children’s Hospital at WestmeadWestmeadAustralia
  3. 3.Department of General MedicineThe Children’s Hospital at WestmeadWestmeadAustralia
  4. 4.The Children’s Hospital at Westmead Clinical SchoolUniversity of SydneySydneyAustralia
  5. 5.ANZDATA Registry SA, Health & Medical Research Institute, Adelaide & Faculty of Health SciencesUniversity of AdelaideAdelaideAustralia
  6. 6.Centre for Renal and Transplant ResearchWestmead HospitalWestmeadAustralia

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