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Effect of BMI on allograft function and survival in pediatric renal transplant recipients

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Abstract

Objective

To determine whether pre-transplant body mass index (BMI) affects renal allograft function and survival in pediatric renal transplant recipients.

Study design

This is a retrospective cohort study using the Organ Procurement and Transplantation Network data from 2000 to 2013 to compare time to total allograft loss (allograft failure or death), prevalence of delayed graft function, prevalence of acute rejection, and estimated glomerular filtration rate (eGFR) post-transplant in pediatric renal transplant recipients categorized by BMI z-score.

Results

A total of 8804 kidney transplant recipients met our inclusion criteria, and of those, 6% were underweight, 14% were overweight, and 17% were obese pre-transplant. The adjusted hazard ratio (HR) for allograft failure was significantly higher for obese recipients compared to normal weight recipients (HR 1.25, 95% CI 1.1, 1.42); for every 1 point increase in BMI z-score, there was a 7% increased hazard of allograft failure (HR 1.07; 95% CI 1.03–1.1, p < 0.001). The prevalence of delayed graft function and acute rejection increased with higher BMI z-score category; however, this difference did not reach statistical significance. eGFR at 1 and 5 years post-transplant decreased with higher BMI z-score although it was only statistically significant at 1 year.

Conclusions

Obesity is prevalent in pediatric renal transplant recipients, and obese, but not overweight or underweight, pediatric renal transplant recipients have an increased risk of allograft failure. Implementation of effective obesity interventions in pediatric renal transplant recipients is of critical importance to improve longevity of the renal allograft.

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Funding

This work was supported by a grant from the Children’s Miracle Network. This work was also supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the US government.

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Authors and Affiliations

  1. Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA

    Erica Winnicki

  2. Department of Pediatrics, University of California, Davis, Sacramento, CA, USA

    Madan Dharmar, Daniel J. Tancredi, Stephanie Nguyen & Lavjay Butani

Authors
  1. Erica Winnicki
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  2. Madan Dharmar
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  3. Daniel J. Tancredi
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  4. Stephanie Nguyen
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Corresponding author

Correspondence to Erica Winnicki.

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The authors declare that they have no conflict of interest.

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Winnicki, E., Dharmar, M., Tancredi, D.J. et al. Effect of BMI on allograft function and survival in pediatric renal transplant recipients. Pediatr Nephrol 33, 1429–1435 (2018). https://doi.org/10.1007/s00467-018-3942-2

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  • DOI: https://doi.org/10.1007/s00467-018-3942-2

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