title: Effects of obesity on kidney transplantation outcomes: a systematic review and meta-analysis.
abstract: BACKGROUND
  The effects of obesity on outcomes reported after kidney transplantation have been controversial. The purpose of this systematic review and meta-analysis was to elucidate this issue.
  
  
  METHODS
  MEDLINE, EMBASE, Cochrane Library, and gray literature were searched up to August 6, 2013. Studies that compared obese and nonobese patients who underwent kidney transplantation and evaluated one of these outcomes-delayed graft function (DGF), acute rejection, graft or patient survival at 1 or 5 years after transplantation, or death by cardiovascular disease (CVD)-were included. Two independent reviewers extracted the data and assessed the quality of the studies.
  
  
  RESULTS
  From 1,973 articles retrieved, 21 studies (9,296 patients) were included. Obesity was associated with DGF (relative risk, 1.41; 95% confidence interval, 1.26-1.57; I=8%; Pheterogeneity=0.36), but not with acute rejection. Graft loss and death were associated with obesity only in the analysis of studies that evaluated patients who received a kidney graft before year 2000. No association of obesity with graft loss and death was found in the analysis of studies that evaluated patients who received a kidney graft after year 2000. Death by CVD was associated with obesity (relative risk, 2.07; 95% confidence interval, 1.17-3.64; I=0%; Pheterogeneity=0.59); however, most studies included in this analysis evaluated patients who received a kidney graft after year 2000.
  
  
  CONCLUSIONS
  In conclusion, obese patients have increased risk for DGF. In the past years, obesity was a risk factor for graft loss, death by CVD, and all-cause mortality. However, for the obese transplanted patient today, the graft and patient survival is the same as that of the nonobese patient.
authors.affiliation: 1 Post Graduation Medical Sciences Program, Endocrinology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 2 Nutrition Course, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 3 Post Graduation Medicine Program, Medical Sciences, School of Medicine, Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 4 Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 5 Post Graduation Medical Sciences Program, Endocrinology, School of Medicine, Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 6 Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 7 Nutrition Course, School of Medicine, Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 8 Address correspondence to: Gabriela Corrêa Souza, Ph.D., Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Bldg 12, 2nd Floor, Room 12201, ZIP code 90035-903, Porto Alegre, Brazil.
authors.forename: Bruna B
authors.initials: BB
authors.lastname: Nicoletto
authors.forename: Natasha K O
authors.initials: NK
authors.lastname: Fonseca
authors.forename: Roberto C
authors.initials: RC
authors.lastname: Manfro
authors.forename: Luiz Felipe S
authors.initials: LF
authors.lastname: Gonçalves
authors.forename: Cristiane Bauermann
authors.initials: CB
authors.lastname: Leitão
authors.forename: Gabriela C
authors.initials: GC
authors.lastname: Souza
mesh_terms: D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D016009:Chi-Square Distribution; D051799:Delayed Graft Function / Q000209:etiology* / Q000401:mortality; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D009765:Obesity / Q000150:complications* / Q000401:mortality; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome