title: The survival benefit of kidney transplantation in obese patients.
abstract: Obese patients have a decreased risk of death on dialysis but an increased risk of death after transplantation, and may derive a lower survival benefit from transplantation. Using data from the United States between 1995 and 2007 and multivariate non-proportional hazards analyses we determined the relative risk of death in transplant recipients grouped by body mass index (BMI) compared to wait-listed candidates with the same BMI (n = 208 498). One year after transplantation the survival benefit of transplantation varied by BMI: Standard criteria donor transplantation was associated with a 48% reduction in the risk of death in patients with BMI ≥ 40 kg/m(2) but a ≥ 66% reduction in patients with BMI < 40 kg/m2. Living donor transplantation was associated with ≥ 66% reduction in the risk of death in all BMI groups. In sub-group analyses, transplantation from any donor source was associated with a survival benefit in obese patients ≥ 50 years, and diabetic patients, but a survival benefit was not demonstrated in Black patients with BMI ≥ 40 kg/m(2). Although most obese patients selected for transplantation derive a survival benefit, the benefit is lower when BMI is ≥ 40 kg/m(2), and uncertain in Black patients with BMI ≥ 40 kg/m(2).
authors.affiliation: Division Of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: J S
authors.initials: JS
authors.lastname: Gill
authors.forename: J
authors.initials: J
authors.lastname: Lan
authors.forename: J
authors.initials: J
authors.lastname: Dong
authors.forename: C
authors.initials: C
authors.lastname: Rose
authors.forename: E
authors.initials: E
authors.lastname: Hendren
authors.forename: O
authors.initials: O
authors.lastname: Johnston
authors.forename: J
authors.initials: J
authors.lastname: Gill
mesh_terms: D044383:Black People / Q000706:statistics & numerical data; D015992:Body Mass Index; D005260:Female; D006084:Graft Rejection / Q000209:etiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D016030:Kidney Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000401:mortality; D015996:Survival Rate; D044465:White People / Q000706:statistics & numerical data