title: Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis.
abstract: BACKGROUND
  The prevalence of obesity is increasing globally and is associated with chronic kidney disease and premature mortality. However, the impact of recipient obesity on kidney transplant outcomes remains unclear. This study aimed to investigate the association between recipient obesity and mortality, death-censored graft loss and delayed graft function (DGF) following kidney transplantation.
  
  
  METHODS
  A systematic review and meta-analysis was conducted using Medline, Embase and the Cochrane Library. Observational studies or randomized controlled trials investigating the association between recipient obesity at transplantation and mortality, death-censored graft loss and DGF were included. Obesity was defined as a body mass index (BMI) of ≥30 kg/m(2). Obese recipients were compared with those with a normal BMI (18.5-24.9 kg/m(2)). Pooled estimates of hazard ratios (HRs) for patient mortality or death-censored graft loss and odds ratios (ORs) for DGF were calculated.
  
  
  RESULTS
  Seventeen studies including 138 081 patients were analysed. After adjustment, there was no significant difference in mortality risk in obese recipients [HR = 1.24, 95% confidence interval (CI) = 0.90-1.70, studies = 5, n = 83 416]. However, obesity was associated with an increased risk of death-censored graft loss (HR = 1.06, 95% CI = 1.01-1.12, studies = 5, n = 83 416) and an increased likelihood of DGF (OR = 1.68, 95% CI = 1.39-2.03, studies = 4, n = 28 847).
  
  
  CONCLUSIONS
  Despite having a much higher likelihood of DGF, obese transplant recipients have only a slightly increased risk of graft loss and experience similar survival to recipients with normal BMI.
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Belfast, UK.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hill
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Belfast, UK.
authors.forename: Aisling E
authors.initials: AE
authors.lastname: Courtney
authors.affiliation: Centre for Public Health, Queen's University Belfast, Belfast, UK.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Cardwell
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Belfast, UK.
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Maxwell
authors.affiliation: Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lucarelli
authors.affiliation: Vascular Surgery and Organ Transplant Unit, University of Catania, Catania, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Veroux
authors.affiliation: Department of Urology and Renal Transplantation, University Hospital, Coimbra, Portugal.
authors.forename: Frederico
authors.initials: F
authors.lastname: Furriel
authors.affiliation: Department of Surgery, University of Louisville, Louisville, KY, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Cannon
authors.affiliation: Department of Nephrology, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Ellen K
authors.initials: EK
authors.lastname: Hoogeveen
authors.affiliation: Department of Internal Medicine, Wayne State University, Detroit, MI, USA.
authors.forename: Mona
authors.initials: M
authors.lastname: Doshi
authors.affiliation: Regional Nephrology Unit, Belfast City Hospital, Belfast, UK.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: McCaughan
mesh_terms: D015992:Body Mass Index; D051799:Delayed Graft Function / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D009765:Obesity / Q000150:complications*; D012307:Risk Factors; D015996:Survival Rate; D066027:Transplant Recipients; D016896:Treatment Outcome
keywords: graft survival; kidney transplantation; mortality; obesity