title: Renal transplantation: better fat than thin.
abstract: BACKGROUND
  Obesity has been a relative contraindication for renal transplantation. This study evaluates the impact of pretransplant body mass index (BMI) on renal transplant outcomes in a single institution in the era of modern immunosuppression.
  
  
  METHODS
  A 10-y retrospective analysis was undertaken of 454 consecutive patients who received a renal transplant at Westmead Hospital from January 1, 2001 to December 31, 2010. The role of pretransplant BMI on patient survival, graft survival, surgical complications, and postoperative complications was studied.
  
  
  RESULTS
  The mean age of transplant of this study population was 45.4 ± 13.0 y. Live donation rate was 53.5%, and 60.6% were male. The median preoperative BMI was 25.6 (range, 14.3-51.4). One-year and 5-y patient survival were 97.4% and 86.6%, respectively, whereas 1-y and 5-y death-censored graft survival were 97.1% and 91.9%, respectively. Patients with BMI >30 did not exhibit any significant difference in survival or graft failure but had higher surgical wound infection rates (hazard ratio 3.95, P < 0.01). Patients with preoperative BMI <18.5 were associated with a six-fold increase in both death and death-censored graft failure (P < 0.01).
  
  
  CONCLUSIONS
  Pretransplant obesity increases wound infection but is not a contraindication to renal transplantation. Future prospective studies are required to further define the impact of low preoperative BMI <18.5.
authors: Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia; Discipline of Surgery, Sydney Medical School, The University of Sydney New South Wales, Australia.
authors: Hsiang
authors: H
authors: Chung
authors: Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia; Discipline of Surgery, Sydney Medical School, The University of Sydney New South Wales, Australia.
authors: Vincent W T
authors: VWT
authors: Lam
authors: Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.
authors: Lawrence P K
authors: LPK
authors: Yuen
authors: Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.
authors: Brendan J
authors: BJ
authors: Ryan
authors: Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia.
authors: Philip J
authors: PJ
authors: O'Connell
authors: Department of Renal Medicine, Westmead Hospital, Westmead, New South Wales, Australia.
authors: Jeremy R
authors: JR
authors: Chapman
authors: Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia; Discipline of Surgery, Sydney Medical School, The University of Sydney New South Wales, Australia.
authors: Wayne J
authors: WJ
authors: Hawthorne
authors: Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia; Discipline of Surgery, Sydney Medical School, The University of Sydney New South Wales, Australia. Electronic address: Henry_Pleass@wsahs.nsw.gov.au.
authors: Henry C
authors: HC
authors: Pleass
mesh_terms: D000328:Adult; D015992:Body Mass Index; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: Body mass index; Dialysis; Kidney transplantation; Obesity