Effect of obesity on the outcome of kidney transplantation: a 20-year follow-up
Abstract
BACKGROUND: Cardiovascular disease is both a major threat to the life expectancy of kidney transplant recipients and an important determinant of late allograft loss. Obesity is an important risk factor for cardiovascular disease. METHODS: We investigated the relation between both pretransplant and 1-year posttransplant body mass index (BMI) with patient and renal graft survival in a cohort of 1810 adult patients. Sixty-one percent of all patients were men; median age (interquartile range [IQR]) was 46 years (35-56 years); median (IQR) pretransplant BMI was 23.0 kg/m (20.8-25.6 kg/m); 1 year after transplantation, the median (IQR) BMI had increased 1.6 kg/m (0.3-3.2 kg/m) and median (IQR) follow-up time was 8.3 years (5.3-12.0 years). We categorized BMI as follows: less than or equal to 20, more than 20 to less than or equal to 25 (normal), more than 25 to less than or equal to 30, and more than 30 (obesity) kg/m. RESULTS: Using a Cox proportional hazards model, after adjustment for cardiovascular risk factors, the relative risks (95% confidence intervals) of death and death-censored graft failure during all follow-up for pretransplant obesity compared with normal BMI were 1.22 (0.86-1.74) and 1.34 (1.02-1.77), respectively; for obesity 1 year after transplantation compared with normal BMI, it was 1.39 (1.05-1.86) and 1.39 (1.10-1.74), respectively; and for change in BMI (per 5 kg/m increment) during the first year after transplantation, it was 1.23 (1.01-1.50) and 1.18 (1.01-1.38), respectively. CONCLUSIONS: One year posttransplant BMI and BMI increment are more strongly related to death and graft failure than pretransplant BMI among kidney transplant recipients. Patients with BMI more than 30 kg/m compared with a normal BMI have approximately 20% to 40% higher risk for death and graft failure.
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BMI after kidney transplantation is more strongly related to adverse long-term outcomes than pre-transplant BMI.
“Overall, the BMI after KTx seems to be more strongly related to adverse long-term outcomes than the pre-transplant BMI (15).”
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- Authors
- Hoogeveen, E. K., Aalten, J., Rothman, K. J., Roodnat, J. I., Mallat, M. J. K., Borm, G., Weimar, W., Hoitsma, A. J., & de Fijter, J. W.
- Affiliations
- Leiden University Medical Center (NL)
- Radboud University Nijmegen (NL)
- RTI International (US)
- Erasmus MC (NL)
- Corresponding author
- Hoogeveen, Ellen K.
- Venue
- Transplantation
- Published
- 2011-04-27
- Volume
- 91
- Issue
- 8
- Pages
- 869-874
- ISSN
- 0041-1337 (ISSN-L)
- OpenAlex
- W1970510113
- Cited by
- 196
- References
- 31
- Citations by year
- 2026: 5 · 2025: 12 · 2024: 9 · 2023: 11 · 2022: 22 · 2021: 21 · 2020: 21 · 2019: 13 · 2018: 14 · 2017: 12 · 2016: 11 · 2015: 9 · 2014: 11 · 2013: 11 · 2012: 8
- FWCI
- 8.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Transplantation (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Health Sciences › Medicine › Surgery › Transplantation: Methods and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Organ Donation and Transplantation
- Keywords
- obesity, kidney transplantation, body mass index, graft survival, cardiovascular disease, post-transplant weight gain, mortality, allograft failure, cardiovascular risk factors
- MeSH terms
- Adult, Female, Follow-Up Studies, Graft Survival, Humans, Immunosuppressive Agents, Kidney Diseases, Male, Middle Aged, Netherlands, Obesity, Registries, Risk Factors, Time Factors, Body Mass Index, Proportional Hazards Models, Kidney Transplantation, Treatment Outcome, Risk Assessment, Kaplan-Meier Estimate
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