title: Selected Mildly Obese Donors Can Be Used Safely in Simultaneous Pancreas and Kidney Transplantation.
abstract: Donor obesity, defined as donor body mass index (D-BMI) of 30 kg/m or greater, has been associated with increased risk of technical failure and poor pancreas allograft outcomes. Many transplant centers establish a threshold of D-BMI of 30 kg/m to decline donor offers for pancreas transplantation. However, no previous studies differentiate the impact of mild (D-BMI, 30-35 kg/m) versus severe obesity (D-BMI, ≥35 kg/m) on pancreas allograft outcomes.
  
  
  
  We examined Organ Procurement Transplant Network database records for 9916 simultaneous pancreas-kidney transplants (SPKT) performed between 2000 and 2013. We categorized donor body mass index (D-BMI) into 4 groups: 20 to 25 (n = 5724), 25 to 30 (n = 3303), 30 to 35 (n = 751), and 35 to 50 kg/m (n= 138). Associations of D-BMI with pancreas and kidney allograft failure were assessed by multivariate Cox regression adjusted for recipient, donor, and transplant factors.
  
  
  
  Compared with D-BMI 20 to 25 kg/m, only D-BMI 35 to 50 kg/m was associated with significantly higher pancreas allograft [adjusted hazard ratio [aHR], 1.37; 95% confidence interval (CI], 1.04-1.79] and kidney allograft (aHR, 1.36; CI, 1.02-1.82) failure over the study period (13 years). Donor BMI 30 to 35 kg/m did not impact pancreas allograft (aHR, 0.99; CI, 0.86-1.37) or kidney allograft (aHR, 0.98; CI, 0.84-1.15) failure. Similar patterns were noted at 3 months, and 1, 5, and 10 years posttransplant.
  
  
  
  These data support that pancreata from mildly obese donors (BMI, 30-35 kg/m) can be safely used for transplantation, with comparable short-term and long-term outcomes as organs from lean donors. Consideration of pancreata from obese donors may decrease the pancreas discard rate.
authors.affiliation: 1 Division of Nephrology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO. 2 Transplant Epidemiology Research Collaboration (TERC), Institute of Public Health, Washington University School of Medicine, St. Louis, MO. 3 Center for Transplantation Research, Saint Louis University School of Medicine, St. Louis, MO. 4 Division of Nephrology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO. 5 Department of Surgery, Washington University School of Medicine, St. Louis, MO. 6 Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO. 7 Division of Nephrology, Department of Medicine, Mayo Clinic, Phoenix, AZ.
authors.forename: Tarek
authors.initials: T
authors.lastname: Alhamad
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Malone
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Jason
authors.initials: J
authors.lastname: Wellen
authors.forename: Su-Hsin
authors.initials: SH
authors.lastname: Chang
authors.forename: Harini A
authors.initials: HA
authors.lastname: Chakkera
mesh_terms: D000328:Adult; D064591:Allografts; D015992:Body Mass Index; D016009:Chi-Square Distribution; D046148:Donor Selection; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods*; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States