title: Outcomes of renal transplantation in obese recipients.
abstract: OBJECTIVE
  Although obesity has been shown to paradoxically increase dialysis patient survival, its impact has not been clearly defined on renal transplantation. We assessed outcomes of obesity renal transplant patients by evaluating graft and patient survivals.
  
  
  METHODS
  A single-institution, retrospective study was performed on 202 renal transplant recipients from January 2004 to December 2008 excluding two combined kidney and liver transplantations. Recipients were classified based on body mass index (BMI) at the time of transplantation: obese (BMI ≥ 30 kg/m(2)) and nonobese recipients (BMI < 30 kg/m(2)). The comparative analysis included surgical complications, hospital stay, onset of delayed graft function (DGF), acute rejection episodes and graft patient survivals.
  
  
  RESULTS
  Twenty-one renal transplants were performed in obese recipients versus 179 in the control group. Obese patients were older (53.3 ± 11.2 versus 46.4 ± 14.4 years old; P = .035) and more often diabetic (29% ± 0.46 versus 60% ± 0.24, P = .001), but there were no differences among other combidities of high blood pressure, arteriopathy, thrombophilia, and smoking. Obesity did not appear to be a risk factor for urinary or vascular as well as parietal complications, but did tend to augment lymphatic complications (14.3% ± 0.36 versus 4.5% ± 0.21; P = .065). DGF occurred more frequently in obese patients (38% ± 0.50 versus 14% ± 0.34; P = .004) and hospital stays were therefore longer in this group (24.9 ± 23.53 days versus 15.6 ± 13.67 days; P = .008). Graft (hazard ratio [HR] 1.22; 95% confidence interval [CI] [0.25-6.0], P = .63) and patient survivals (HR:0,81; 95% CI [0.12- 5.3], P = .83) were comparable between the groups.
  
  
  CONCLUSIONS
  Obese patients seeking renal transplantation are usually older and more often diabetic compared with nonobese recipients. The higher rate of lymphatic complications and DGF lead to longer hospital stays among the group with BMI ≥ 30 kg/m(2). However, long-term results showed similar graft and patient survivals as nonobese patients. Consequently, there seemed to be no reason to avoid renal transplantation in obese recipients.
authors.affiliation: Department of Urology and Renal Transplantation, University Hospital Saint-Jacques, Besançon, France.
authors.forename: N
authors.initials: N
authors.lastname: Bardonnaud
authors.forename: P
authors.initials: P
authors.lastname: Pillot
authors.forename: J
authors.initials: J
authors.lastname: Lillaz
authors.forename: G
authors.initials: G
authors.lastname: Delorme
authors.forename: E
authors.initials: E
authors.lastname: Chabannes
authors.forename: S
authors.initials: S
authors.lastname: Bernardini
authors.forename: G
authors.initials: G
authors.lastname: Guichard
authors.forename: H
authors.initials: H
authors.lastname: Bittard
authors.forename: F
authors.initials: F
authors.lastname: Kleinclauss
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015897:Comorbidity; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D005602:France; D006084:Graft Rejection / Q000276:immunology; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D008206:Lymphatic Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult