title: Consequences of Recipient Obesity on Postoperative Outcomes in a Renal Transplant: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  The prevalence of obesity is increasing rapidly and globally, yet systemic reviews on this topic are scarce. Our meta-analysis and systemic review aimed to assess how obesity affects 5 postoperative outcomes: biopsy-proven acute rejection, patient death, allograft loss, type 2 diabetes mellitus after transplant, and delayed graft function.
  
  
  METHODS
  We evaluated peer-reviewed literature from 22 medical databases. Studies were included if they were conducted in accordance with the Meta-analysis of Observational Studies in Epidemiology criteria, only examined postoperative outcomes in adult patients, only examined the relation between recipient obesity at time of transplant and our 5 postoperative outcomes, and had a minimum score of > 5 stars on the Newcastle-Ottawa scale for nonrandomized studies. Reliable conclusions were ensured by having our studies examined against 2 internationally known scoring systems. Obesity was defined in accordance with the World Health Organization as having a body mass index of > 30 kg/m(2). All obese recipients were compared versus "healthy" recipients (body mass index of 18.5-24.9 kg/m(2)). Hazard ratios were calculated for biopsy-proven acute rejection, patient death, allograft loss, and type 2 diabetes mellitus after transplant. An odds ratio was calculated for delayed graft function.
  
  
  RESULTS
  We assessed 21 retrospective observational studies in our meta-analysis (N = 241 381 patients). In obese transplant recipients, hazard ratios were 1.51 (95% confidence interval, 1.24-1.78) for presence of biopsy-proven acute rejection, 1.19 (95% confidence interval, 1.10-1.31) for patient death, 1.54 (95% confidence interval, 1.38-1.68) for allograft loss, and 1.01 (95% confidence interval, 0.98-1.07) for development of type 2 diabetes mellitus. The odds ratio for delayed graft function was 1.81 (95% confidence interval, 1.51-2.13).
  
  
  CONCLUSIONS
  Our meta-analysis clearly demonstrated greater risks for obese renal transplant recipients and poorer postoperative outcomes with obesity. We confidently recommend renal transplant candidates seek medically supervised weight loss before transplant.
authors.affiliation: From the Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Anshuman
authors.initials: A
authors.lastname: Sood
authors.forename: David N
authors.initials: DN
authors.lastname: Hakim
authors.forename: Nadey S
authors.initials: NS
authors.lastname: Hakim
mesh_terms: D051799:Delayed Graft Function / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D009765:Obesity / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D066027:Transplant Recipients; D016896:Treatment Outcome