title: Kidney Transplantation Significantly Improves Patient and Graft Survival Irrespective of BMI: A Cohort Study.
abstract: Obesity and end-stage renal disease (ESRD) are on the increase worldwide. Kidney transplantation is the treatment of choice for ESRD. However, obesity is considered a contraindication for transplantation. We investigated the effect of BMI on mortality in transplanted and patients remaining on the waiting list in the United Kingdom. We analyzed the UK Renal Registry (RR) and the National Health Service Blood and Transplant (NHSBT) Organ Donation and Transplantation data for patients listed from January 1, 2004 to December 31, 2010, with follow-up until December 31, 2011. Seventeen thousand six hundred eighty-one patients were listed during the study period, with BMI recorded for 13 526 (77%). One- and five-year patient survival was significantly better in all BMI bands (<18.5, 18.5-<25, 25-<30, 30-<35, 35-<40, and 40+kg/m(2) ) in the transplant group when compared to those who remained on the waiting list (p < 0.0001). The analyses were repeated excluding live donor transplants and the results were essentially the same. On analyses of patient survival with BMI as a continuous variable or using 5 kg weight bands, there was no cut-off observed in the higher BMI patients where there would be no benefit to transplantation. For transplanted patients (N = 8088), there was no difference in patient or graft survival between the defined BMI bands. Thus, irrespective of BMI, patient survival is improved if transplanted.
authors.affiliation: Consultant Transplant Nephrologist, Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: N
authors.initials: N
authors.lastname: Krishnan
authors.affiliation: Consultant Transplant Nephrologist, Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: R
authors.initials: R
authors.lastname: Higgins
authors.affiliation: Consultant Transplant Nephrologist, Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: A
authors.initials: A
authors.lastname: Short
authors.affiliation: Consultant Transplant Nephrologist, Renal Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: D
authors.initials: D
authors.lastname: Zehnder
authors.affiliation: Renal Registry, Bristol, UK.
authors.forename: D
authors.initials: D
authors.lastname: Pitcher
authors.affiliation: Organ Donation, NHS Blood and Transplant, Bristol, UK.
authors.forename: A
authors.initials: A
authors.lastname: Hudson
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: N T
authors.initials: NT
authors.lastname: Raymond
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D015996:Survival Rate; D006113:United Kingdom; D014850:Waiting Lists; D055815:Young Adult
keywords: Obesity; registry/registry analysis