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.
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Overweight and obesity after kidney transplantation are associated with adverse outcomes.
“Overweight and obesity after KTx are strongly associated with adverse outcomes.”
From Cognitive-behavioral and dietary weight loss intervention in adult kidney transplant recipients with overweight and obesity: Results of a pilot RCT study (Adi-KTx) (2023) · cites this paper as [11]
The Discussion reports that obese kidney-transplant recipients were more likely to develop delayed graft function and had a marginally greater risk of death-censored graft loss, but no significant increase in mortality. The paper examines obesity at transplantation, not overweight or weight gained after transplantation; its findings also do not support describing the association with adverse outcomes generally as strong. (LLM, conf=0.89)
Experimental — accuracy not yet measuredObesity after kidney transplantation is associated with higher rates of early complications, including delayed graft functioning and surgical complications, and higher rates of adverse long-term complications such as cardiovascular diseases.
“They reported higher rates of complications early after transplantation, including delayed graft functioning and surgical complications as well as a higher rate of adverse long-term complications such as cardiovascular diseases.”
From Cognitive-behavioral and dietary weight loss intervention in adult kidney transplant recipients with overweight and obesity: Results of a pilot RCT study (Adi-KTx) (2023) · cites this paper as [11]
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Experimental — accuracy not yet measuredFindings on the association between obesity and graft loss and morbidity after kidney transplantation are controversial.
“Regarding the association between obesity and graft loss as well as morbidity, the findings are controversial (6, 10–13).”
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- Authors
- Hill, C. J., Courtney, A. E., Cardwell, C. R., Maxwell, A. P., Lucarelli, G., Veroux, M., Furriel, F., Cannon, R. M., Hoogeveen, E. K., Doshi, M., & McCaughan, J. A.
- Affiliations
- Belfast City Hospital (GB)
- University of Bari Aldo Moro (IT)
- University of Catania (IT)
- Unidade Local de Saúde de Coimbra (PT)
- University of Louisville (US)
- Leiden University Medical Center (NL)
- Wayne State University (US)
- Corresponding author
- Hill, Christopher J.
- ORCID
- Venue
- Nephrology Dialysis Transplantation
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-06-04
- Volume
- 30
- Issue
- 8
- Pages
- 1403-1411
- ISSN
- 0931-0509 (ISSN-L)
- 1460-2385
- OpenAlex
- W2188967216
- Cited by
- 201
- References
- 57
- Citations by year
- 2026: 11 · 2025: 13 · 2024: 15 · 2023: 21 · 2022: 22 · 2021: 32 · 2020: 20 · 2019: 25 · 2018: 10 · 2017: 12 · 2016: 16 · 2015: 3
- FWCI
- 2.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nephrology Dialysis Transplantation (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (Queen's University Belfast) (submittedVersion)
- CINECA IRIS Institutional Research Information System (University of Bari Aldo Moro) (submittedVersion)
- Funders
- Kidney Research UK (TF20/2012)
- Public Health Agency (STL/3714/07)
- Topics
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Organ Donation and Transplantation
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Keywords
- kidney transplantation, graft loss, delayed graft function, post-transplant mortality, body mass index, transplant outcomes
- MeSH terms
- Graft Survival, Humans, Kidney Failure, Chronic, Obesity, Risk Factors, Body Mass Index, Survival Rate, Kidney Transplantation, Treatment Outcome, Delayed Graft Function, Transplant Recipients
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