Body mass index and mortality in kidney transplant recipients: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: A higher body mass index (BMI) seems to be linked to survival advantage in maintenance hemodialysis patients. However, it is uncertain if this 'obesity survival paradox' is also observed in kidney transplant recipients. Hence, we systematically reviewed the literature on the impact of pre-transplantation BMI on all-cause mortality in this population. METHODS: We searched MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane CENTRAL for relevant studies up to July 2013. Two investigators independently selected the studies using predefined criteria, abstracted the data from the included studies, and independently assessed each study's quality using the Newcastle-Ottawa Quality Assessment Scale. In addition to the qualitative synthesis, we quantitatively pooled the results of the studies with clinical, methodological, and statistical homogeneity. RESULTS: We screened 7,123 records, from which we included 11 studies (with a total of 305,392 participants) in this systematic review and 4 studies in the meta-analyses. In the only study that included children, obesity was linked to higher mortality in children of 6-12 years old. For adults, our meta-analyses indicated that compared to normal BMI, underweight [Hazard Ratio (HR): 1.09; 95% Confidence Interval (CI): 1.02-1.20], overweight (HR: 1.07; 95% CI: 1.04-1.12), and obese (HR: 1.20; 95% CI: 1.14-1.23) levels of BMI were associated with higher mortality. CONCLUSION: The presence of the obesity survival paradox is unlikely in kidney transplant recipients since both extremes of pre-transplantation BMI are linked to higher mortality in this population.
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Findings 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).”
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 [10]
The Results (Studies of adults; page unavailable) report higher graft-failure risk in obese recipients, and the Introduction (page unavailable) associates post-transplant obesity with graft failure and several morbidities. The paper does not describe findings on obesity and those outcomes as controversial; the uncertainty it identifies concerns pre-transplant BMI and mortality. (LLM, conf=0.76)
Experimental — accuracy not yet measuredOverweight 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 [10]
The Introduction says post-transplantation obesity is associated with mortality, graft failure, and other adverse outcomes. But the Discussion says the effect of being overweight on survival is still unclear, so the paper does not support a strong adverse-outcome association for both overweight and obesity. Page numbers were not provided in our copy. (LLM, conf=0.90)
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 [10]
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- Authors
- Ahmadi, S.-F., Zahmatkesh, G., Streja, E., Molnar, M. Z., Rhee, C. M., Kovesdy, C. P., Gillen, D. L., Steiner, S., & Kalantar-Zadeh, K.
- Affiliations
- University of California, Irvine Medical Center (US)
- University of Tennessee Health Science Center (US)
- Memphis VA Medical Center (US)
- University of California, Irvine (US)
- ORCID
- Venue
- American Journal of Nephrology
- Publisher
- S. Karger AG
- Published
- 2014
- Volume
- 40
- Issue
- 4
- Pages
- 315-324
- ISSN
- 0250-8095 (ISSN-L)
- 1421-9670
- PMC
- PMC4319181
- OpenAlex
- W2083852602
- Cited by
- 103
- References
- 22
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 6 · 2023: 7 · 2022: 9 · 2021: 13 · 2020: 6 · 2019: 7 · 2018: 11 · 2017: 9 · 2016: 8 · 2015: 13
- FWCI
- 1.81
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Nephrology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- National Institutes of Health
- National Institute on Aging (R21AG047036)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK078106, R13DK094686, R01DK096920, R01DK095668, K24DK091419)
- Topics
- Health Sciences › Medicine › Transplantation › Renal Transplantation Outcomes and Treatments
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- body mass index, kidney transplant recipients, all-cause mortality, underweight, overweight, obesity, children, hemodialysis
- MeSH terms
- Adult, Child, Graft Survival, Humans, Body Mass Index, Kidney Transplantation
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