Obesity, surgical site infection, and outcome following renal transplantation.
OBJECTIVE
We sought to understand whether obesity imparts detriment in outcome beyond risk of developing surgical site infection (SSI).


BACKGROUND
Obesity is a risk factor for SSI following renal transplantation, and has been implicated in inferior patient and graft survival postoperatively.


METHODS
We conducted a retrospective review of all adult kidney-only transplants performed at the University of Michigan between September 2003 and April 2008. The primary exposure variable was recipient body mass index (BMI). Cox multivariable regression and Kaplan-Meier analysis were used to identify factors associated with SSI, graft loss, and patient death.


RESULTS
In total, 869 recipients were studied, including 351 with BMI >30. Multivariate analysis revealed recipient age, delayed graft function, and BMI >30 to be independent risk factors for SSI. SSI was a significant risk factor for graft loss (HR: 2.194, 95% CI: 1.357-3.546) and approached significance as a risk factor for patient death (HR: 1.689, 95% CI: 0.941-3.028). Obesity had no independent effect on graft or patient outcome.


CONCLUSIONS
SSI is associated with detriment to patient and graft survival following renal transplantation. The prevalence of SSI is higher among obese recipients, but those who avoid SSI have comparable outcomes to nonobese recipients. These findings redemonstrate the importance of SSI prevention following renal transplantation.
Division of Transplantation, Department of Surgery, University of Michigan, Ann Arbor, MI 48109-0342, USA. raylynch@umich.edu
Raymond J
RJ
Lynch
David N
DN
Ranney
Cai
C
Shijie
Dennis S
DS
Lee
Niharika
N
Samala
Michael J
MJ
Englesbe
D000328:Adult; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000453:epidemiology; D051437:Renal Insufficiency / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome