Abstract
Introduction
We assessed the effect of recipient body mass index (BMI) on the outcomes of renal transplantation and the management of obese patients with end-stage renal disease across the UK.
Methods
We analyzed data of 25539 adult renal transplants (2007–2016) from the UK Transplant Registry. Patients were divided in BMI groups [underweight: < 18.5, normal: 18.5–24.9 (reference group), overweight: 25–29.9, class I obese: 30–34.9, class II/III obese: ≥ 35]. We also conducted a national survey of all UK renal transplant centers on the influence of BMI on decisions regarding management of renal transplant candidates.
Results
BMI ≥ 25 was an independent risk factor for delayed graft function and primary non-function (p ≤ 0.001). Underweight (p = 0.001), class I obese (p = 0.017) and class II/III obese recipients (p < 0.001) had poorer graft survival, however, 5- and 10-year graft survival rates were good. Patient survival was shorter for underweight recipients (p < 0.001) and longer for overweight (p = 0.028) and class I obese recipients (p = 0.013). The national survey revealed significant variability among transplant centers in BMI threshold for listing patients on transplant waiting list and limited support with conservative or surgical procedures for weight control.
Conclusions
Obesity alone should not be a barrier for renal transplantation. A national strategy is required to give all patients equal chances in transplantation.
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Acknowledgements
We would like to thank Ms Lisa Mumford for her valuable assistance in providing the data from NHSBT and her useful comments on their analysis.
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IDK and TK: Literature search, study design, data analysis and interpretation, manuscript preparation and revision; VB: Literature search, data analysis and interpretation, manuscript preparation; PP: Study design, data analysis and interpretation, manuscript preparation; CF: Data analysis and interpretation, manuscript revision; CC, BP, NKa, NK: Literature search, data interpretation, manuscript revision; FC: Literature search, study design, data analysis and interpretation, manuscript revision; IL: Literature search, study design, data analysis and interpretation, manuscript preparation and revision.
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All the authors declare that there is no financial support from any organisation for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work and no other relationships or activities that could appear to have influenced the submitted work. All the authors declare that there are no conflicts of interest.
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Our study conforms to the 2000 Declaration of Helsinki and the 2008 Declaration of Istanbul.
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Not applicable. Retrospective study based on the UK Transplant Registry of NHSBT.
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Kostakis, I.D., Kassimatis, T., Bianchi, V. et al. UK renal transplant outcomes in low and high BMI recipients: the need for a national policy. J Nephrol 33, 371–381 (2020). https://doi.org/10.1007/s40620-019-00654-7
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DOI: https://doi.org/10.1007/s40620-019-00654-7