Obesity in pediatric kidney transplant recipients and the risks of acute rejection, graft loss and death
- 556 Downloads
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.
KeywordsAcute rejection Body mass index Graft survival Kidney transplantation Obesity Pediatrics
Compliance with ethical standards
The authors declare that they have no conflicts of interest.
ML is the recipient of an NHMRC Postgraduate Scholarships Grant: Clinical Postgraduate Research Scholarship APP1074409.
- 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
- 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 384:766–781CrossRefPubMedPubMedCentralGoogle 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-iv204Google 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 25:617–624CrossRefPubMedGoogle 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)
- 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 39:2205–2207Google Scholar