Body mass index and outcome in renal transplant recipients: a systematic review and meta-analysis
Open accessAbstract
BACKGROUND: Whether overweight or obese end stage renal disease (ESRD) patients are suitable for renal transplantation (RT) is often debated. The objective of this review and meta-analysis was to systematically investigate the outcome of low versus high BMI recipients after RT. METHODS: Comprehensive searches were conducted in MEDLINE OvidSP, Web of Science, Google Scholar, Embase, and CENTRAL (the Cochrane Library 2014, issue 8). We reviewed four major guidelines that are available regarding (potential) RT recipients. The methodology was in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and written based on the PRISMA statement. The quality assessment of studies was performed by using the GRADE tool. A meta-analysis was performed using Review Manager 5.3. Random-effects models were used. RESULTS: After identifying 5,526 studies addressing this topic, 56 studies were included. We extracted data for 37 outcome measures (including data of more than 209,000 RT recipients), of which 26 could be meta-analysed. The following outcome measures demonstrated significant differences in favour of low BMI (<30) recipients: mortality (RR = 1.52), delayed graft function (RR = 1.52), acute rejection (RR = 1.17), 1-, 2-, and 3-year graft survival (RR = 0.97, 0.95, and 0.97), 1-, 2-, and 3-year patient survival (RR = 0.99, 0.99, and 0.99), wound infection and dehiscence (RR = 3.13 and 4.85), NODAT (RR = 2.24), length of hospital stay (2.31 days), operation duration (0.77 hours), hypertension (RR = 1.35), and incisional hernia (RR = 2.72). However, patient survival expressed in hazard ratios was in significant favour of high BMI recipients. Differences in other outcome parameters were not significant. CONCLUSIONS: Several of the pooled outcome measurements show significant benefits for 'low' BMI (<30) recipients. Therefore, we postulate that ESRD patients with a BMI >30 preferably should lose weight prior to RT. If this cannot be achieved with common measures, in morbidly obese RT candidates, bariatric surgery could be considered.
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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 [12]
The Discussion (page unavailable) concludes that obesity before renal transplantation is associated with worse outcomes afterward, and reports more surgical complications in higher-BMI recipients. The cited analysis does not establish the same association separately for overweight recipients or for weight gained after transplantation. (LLM, conf=0.85)
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 [12]
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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).”
Overweight is associated with the development of new-onset diabetes after transplantation (NODAT) and hypertension.
“Additionally, an association between overweight and the development of new-onset diabetes after transplantation (NODAT) and hypertension has been described (12).”
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“Additionally, an association between overweight and the development of new-onset diabetes after transplantation (NODAT) and hypertension has been described (12).”
BackgroundGillespie, H., O’Neill, S., Curtis, R. M. K., Callaghan, C. J., & Courtney, A. E. (2023) · Transplant International · doi:10.3389/ti.2023.11428 · Cited by 10 · see citing works
- Authors
- Lafranca, J. A., IJermans, J. N., Betjes, M. G., & Dor, F. J.
- Affiliations
- Erasmus MC (NL)
- Corresponding author
- Dor, Frank JMF
- Venue
- BMC Medicine
- Published
- 2015-05-12
- Volume
- 13
- Issue
- 1
- Pages
- 111-111
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC4427990
- OpenAlex
- W4211251578
- Cited by
- 222
- References
- 103
- Citations by year
- 2026: 20 · 2025: 15 · 2024: 15 · 2023: 26 · 2022: 31 · 2021: 34 · 2020: 14 · 2019: 22 · 2018: 13 · 2017: 18 · 2016: 9 · 2015: 2
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Update notices
- erratum (2015-06-15)
- Open access
- gold
- doi.org
- Locations
- BMC Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
- 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
- body mass index, kidney transplantation, obesity, end-stage renal disease, transplant outcomes, graft survival, mortality, delayed graft function, acute rejection, wound infection, bariatric surgery, weight loss, morbid obesity
- MeSH terms
- Female, Humans, Obesity, Morbid, Body Mass Index, Kidney Transplantation, Treatment Outcome, Transplant Recipients
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