Impact of pretransplant body mass index on early kidney graft function.
BACKGROUND
An increase in the number of obese patients on transplantation waiting lists can be observed. There are conflicting results regarding the influence of body mass index (BMI) on graft function.


METHODS
We performed a single-center, retrospective study of 859 adult patients who received a renal graft from deceased donors. BMI (kg/m(2)) was calculated from patients' height and weight at the time of transplantation. Kidney recipients were subgrouped into 4 groups, according to their BMI: Groups A (<18.5; n = 57), B (18.6-24.9; n = 565), C (25-29.9; n = 198) and D (>30; n = 39). Primary or delayed graft function (DGF), acute rejection (AR) episodes, and number of reoperations, graft function expressed by glomerular filtration rate (GFR) and serum creatinine concentration and number of graft loss as well as the recipient's death were analyzed. The follow-up period was 1 year.


RESULTS
Obese patients' grafts do not develop any function more frequently in comparison with their nonobese counterparts (P < .0001; odds ratio [OR], 32.364; 95% CI, 2.174-941.422). Other aspects of the procedure were analyzed to confirm that thesis: Cold ischemia time and number of HLA mismatches affect the frequency of AR (OR, 1.0182 [P = .0029] and OR, 1.1496 [P = .0147], respectively); moreover, donor median creatinine serum concentration (P = .00004) and cold ischemia time (P = .00019) are related to delayed graft function. BMI did not influence the incidence of DGF (P = .08, OR; 1.167; 95% CI, 0.562-2.409), the number of AR episodes (P > .1; OR, 1.745; 95% CI, 0.846-3.575), number of reoperations, GFR (P = .22-.92), or creatinine concentration (P = .09). Number of graft losses (P = .12; OR, 1.8; 95% CI, 0.770-4.184) or patient deaths (P = .216; OR, 3.69; 95% CI, 0.153-36.444) were not influenced.


CONCLUSIONS
Greater recipient BMI at the time of transplantation has a significant influence on the incidence of primary graft failure.
Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland. Electronic address: rafal.kieszek@wum.edu.pl.
R
R
Kieszek
Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
A
A
Kwiatkowski
Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
K
K
Jędrzejko
Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
P
P
Domagała
Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
M
M
Bieniasz
Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
M
M
Wszoła
Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
J
J
Drozdrowski
Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
A
A
Tomaszek
Department of Transplant Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland.
J
J
Gozdowska
Department of Immunology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
D
D
Zygier
Department of Immunology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.
L
L
Pączek
Department of Transplant Medicine and Nephrology, Medical University of Warsaw, Warsaw, Poland.
M
M
Durlik
Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
A
A
Chmura
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D051799:Delayed Graft Function / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology*; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D016017:Odds Ratio; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult