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

Pediatric Nephrology volume 32, pages 1443–1450 (2017)Cite this article

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.

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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

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  1. Maleeka Ladhani
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  2. Samantha Lade
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  3. Stephen I. Alexander
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Correspondence to Maleeka Ladhani.

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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.

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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

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

Keywords

  • Acute rejection
  • Body mass index
  • Graft survival
  • Kidney transplantation
  • Obesity
  • Pediatrics