title: Effect of donor body mass index on the outcome of donation after cardiac death kidneys: how big is too big?
abstract: BACKGROUND
  Morbid obesity (MO) has become an epidemic in the United Sates and is associated with adverse effects on health. The purpose of this study was to examine the effects of MO on the short-term outcomes of kidneys transplanted from donation after cardiac death (DCD) donors.
  
  
  METHODS
  Using a prospectively collected database, we reviewed 467 kidney transplantations performed at a single center between January 2008 and June 2011 to identify 67 recipients who received transplants from 40 DCD donors. The outcomes of 14 MO DCD donor kidneys were compared with 53 non-MO DCD grafts. MO was defined as a body mass index ≥ 35. Mean patient follow-up was 16 months.
  
  
  RESULTS
  The MO and non-MO DCD donor groups were similar with respect to donor and recipient age, gender, race, cause of death and renal disease, time from withdrawal of life support to organ perfusion, mean human leukocyte antigen (HLA) mismatch, and overall recipient survival. Organs from MO DCD donors also had comparable rates of delayed graft function (21.4% vs 20.0%; P = not significant [NS]). At 1 year post-transplantation, a small but statistically insignificant difference was observed in the graft survival rates of MO and non-MO donors (87% vs. 96%; P = NS). One MO kidney had primary nonfunction.
  
  
  CONCLUSIONS
  These data demonstrate that kidneys procured from MO DCD donors have equivalent short-term outcomes compared with non-MO grafts and should continue to be used. Further investigation is needed to examine the effect of MO on long-term renal allograft survival.
authors: Washington University School of Medicine, St. Louis, Missouri, USA.
authors: L X
authors: LX
authors: Jin
authors: Department of Surgery, Section of Transplant Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors: S C
authors: SC
authors: Pitt
authors: Department of Surgery, Section of Transplant Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors: M B
authors: MB
authors: Doyle
authors: Department of Medicine, Division of Nephrology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors: C
authors: C
authors: Klein
authors: Department of Surgery, Section of Transplant Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors: S
authors: S
authors: Shenoy
authors: Department of Surgery, Section of Transplant Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors: J A
authors: JA
authors: Lowell
authors: Department of Surgery, Section of Transplant Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
authors: W C
authors: WC
authors: Chapman
authors: Department of Surgery, Section of Transplant Surgery, Washington University School of Medicine, St. Louis, Missouri, USA. Electronic address: wellenj@wudosis.wustl.edu.
authors: J R
authors: JR
authors: Wellen
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016208:Databases, Factual; D003643:Death; D051799:Delayed Graft Function / Q000209:etiology; D005260:Female; D006085:Graft Survival; D006801:Humans; D007668:Kidney / Q000473:pathology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid; D011446:Prospective Studies; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome