title: Increased alloreactivity and adverse outcomes in obese kidney transplant recipients are limited to those with diabetes mellitus.
abstract: Previous studies on patient and allograft outcomes of obese kidney transplant recipients (KTRs) remain controversial. To what extent obesity-related comorbidities contribute to adverse outcomes, however, hasn't been addressed. We studied all KTRs from 2005 to 2012. 29 (4%), 317 (48%), 217 (33%), 76 (12%), and 21 KTRs (4%) were identified as underweight, normal-weight, overweight, obese, and morbid obese, respectively. 33 of 97 obese KTRs (34%) had pre-existent diabetes. Samples were collected before transplantation and at +1, +2, +3months posttransplantation. Donor-reactive T-cells were measured using an interferon-γ Elispot assay. Obese KTRs showed an increased incidence pre-existent diabetes (p<0.001), but no differences for hypertension and coronary artery disease (p>0.05). Among obese KTRs, those with pre-existent diabetes showed inferior patient and allograft survival, worse allograft function, delayed graft function, and prolonged hospitalization (p<0.05). Interestingly, no differences were observed between obese non-diabetic, normal-weight diabetic, and normal-weight non-diabetic KTRs (p>0.05). Obese diabetic KTRs showed higher frequencies of donor-reactive T-cells pretransplantation (p<0.05). Our results suggest that the increased risk of mortality, allograft loss, delayed graft function, and prolonged hospitalization in obese KTRs is limited to those with diabetes. A state of obesity-related inflammation plus hyperglycemia may trigger increased alloreactivity and should call for adequate immunosuppression.
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany; Berlin-Brandenburg, Center of Regenerative Therapies (BCRT), Berlin, Germany; Berlin Institute of Health (BIH), Charité and Max-Delbrück Center, Berlin, Germany. Electronic address: thomas.schachtner@charite.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schachtner
authors.affiliation: Berlin-Brandenburg, Center of Regenerative Therapies (BCRT), Berlin, Germany.
authors.forename: Maik
authors.initials: M
authors.lastname: Stein
authors.affiliation: Department of Nephrology and Internal Intensive Care, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany; Berlin-Brandenburg, Center of Regenerative Therapies (BCRT), Berlin, Germany.
authors.forename: Petra
authors.initials: P
authors.lastname: Reinke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D048909:Diabetes Complications / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D058501:Enzyme-Linked Immunospot Assay; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007371:Interferon-gamma / Q000378:metabolism; D007519:Isoantigens / Q000276:immunology; D016030:Kidney Transplantation / Q000009:adverse effects; D007902:Length of Stay / Q000706:statistics & numerical data; D008213:Lymphocyte Activation; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D012306:Risk; D016019:Survival Analysis; D013601:T-Lymphocytes / Q000276:immunology*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007519:Isoantigens; D007371:Interferon-gamma
keywords: Alloreactivity; Diabetes mellitus; Obesity; Renal transplantation