title: Impact of recipient body mass index on short-term and long-term survival of pancreatic grafts.
abstract: BACKGROUND
  The impact of recipient body mass index on graft and patient survival after pancreas transplantation is not well known.
  
  
  METHODS
  We have analyzed data from all pancreas transplant recipients reported in the Scientific Registry of Transplant Recipients between 1987 and 2011. Recipients were categorized into BMI classes, as defined by the World Health Organization. Short-term (90 days) and long-term (90 days to 5 years) patient and graft survivals were analyzed according to recipient BMI class using Kaplan-Meier estimates. Hazard ratios were estimated using Cox proportional hazard models.
  
  
  RESULTS
  A total of 21,075 adult recipients were included in the analysis. Mean follow-up was 5 ± 1.1 years. Subjects were overweight or obese in 39%. Increasing recipient BMI was an independent predictor of pancreatic graft loss and patient death in the short term (P<0.001), especially for obese class II patient survival (hazard ratio, 2.07; P=0.009). In the long term, obesity, but not overweight, was associated with higher risk of graft failure (P=0.01). Underweight was associated with a higher risk of long-term death (P<0.001).
  
  
  CONCLUSIONS
  These results question the safety of pancreas transplantation in obese patients and suggest that they may be directed to alternate therapies, such as behavioral modifications or bariatric surgery, before pancreas transplantation is considered.
authors.affiliation: 1 Division of Visceral and Transplantation Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Genève, Switzerland. 2 Division of Clinical Epidemiology, University of Geneva Hospitals and School of Medicine, Genève, Switzerland.
authors.forename: Benoît
authors.initials: B
authors.lastname: Bédat
authors.forename: Nadja
authors.initials: N
authors.lastname: Niclauss
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Jannot
authors.forename: Axel
authors.initials: A
authors.lastname: Andres
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Thierry
authors.initials: T
authors.lastname: Berney
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000401:mortality; D018579:Patient Selection; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013851:Thinness / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D014481:United States