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Outcomes of underweight, overweight, and obese pediatric kidney transplant recipients

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Abstract

Background

Obesity is a risk factor for poor transplant outcomes in the adult population. The effect of pre-transplant weight on pediatric kidney transplantation is conflicting in the existing literature.

Methods

Data was collected from the Organ Procurement and Transplantation Network (OPTN) database on recipients aged 2–21 years who received a kidney-only transplant from 1987 to 2017. Recipients were categorized into underweight, normal, overweight, and obese cohorts. Using adjusted regression models, the relationship between recipient weight and various graft outcomes (delayed graft function [DGF], acute rejection, prolonged hospitalization, graft failure, mortality) was examined.

Results

18,261 transplant recipients (mean age 14.1 ± 5.5 years) were included, of which 8.7% were underweight, 14.8% were overweight, and 15% were obese. Obesity was associated with greater odds of DGF (OR 1.3 95% CI 1.13–1.49, p < 0.001), acute rejection (OR 1.23 95% CI 1.06–1.43, p < 0.01), and prolonged hospitalization (OR 1.35 95% CI 1.17–1.54, p < 0.001) as well as greater hazard of graft failure (HR 1.13 95% CI 1.05–1.22, p = 0.001) and mortality (HR 1.19 95% CI 1.05–1.35, p < 0.01). The overweight cohort had an increased risk of graft failure (HR 1.08 95% CI 1.001–1.16, p = 0.048) and increased odds of DGF (OR 1.2 95% CI 1.04–1.38, p = 0.01) and acute rejection (OR 1.18 95% CI 1.01–1.38, p = 0.04). When stratified by age group, the increased risk was realized among younger and older age groups for obese and overweight. Underweight had lower risk of 1-year graft failure (HR 0.82 95% CI 0.71–0.94, p < 0.01), overall graft failure in the 13–17-yr. age group (HR 0.84 95% CI 0.72–0.99, p = 0.03) and acute rejection in the 2–5-yr. age group (OR 0.24 95% CI 0.09–0.66, p < 0.01).

Conclusion

Pre-transplant weight status and age impact pediatric kidney transplant outcomes. Recipient underweight status seems to be protective against adverse outcomes while overweight and obesity may lead to poorer graft and patient outcomes.

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Acknowledgements

This work was 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 U.S. Government.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Nephrology and Kidney Transplantation, Cohen Children’s Medical Center of New York, 269-01 76th Avenue, New Hyde Park, NY, 11040, USA

    Kiranjot Kaur, Daniel Jun, Elliot Grodstein, Pamela Singer, Laura Castellanos, Lewis Teperman, Ernesto Molmenti, Ahmed Fahmy, Rachel Frank, Lulette Infante & Christine B. Sethna

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  1. Kiranjot Kaur
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  2. Daniel Jun
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  3. Elliot Grodstein
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  4. Pamela Singer
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  5. Laura Castellanos
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  6. Lewis Teperman
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  7. Ernesto Molmenti
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  8. Ahmed Fahmy
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  9. Rachel Frank
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  11. Christine B. Sethna
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Contributions

K.K contributed to data analysis and writing of the manuscript. D.J. contributed to study design, performance of the research, data analysis, and writing of the manuscript. C.S. contributed to the study design, data analysis, writing of the manuscript, and supervision of the research. P.S., R.F., L.I., L.C, L.T, E.M, E.G., and A.F. contributed to the study concept and writing of the manuscript.

Corresponding author

Correspondence to Christine B. Sethna.

Ethics declarations

The study did not require review by the Institutional Review Board of Northwell Health as it did not meet criteria for human subject research.

Conflict of interest

The authors report no conflicts of interest.

Additional information

Kiranjot Kaur and Daniel Jun are Co-first Authors

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Kaur, K., Jun, D., Grodstein, E. et al. Outcomes of underweight, overweight, and obese pediatric kidney transplant recipients. Pediatr Nephrol 33, 2353–2362 (2018). https://doi.org/10.1007/s00467-018-4038-8

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  • DOI: https://doi.org/10.1007/s00467-018-4038-8

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