Impact of renal transplantation on survival in end-stage renal disease patients with elevated body mass index

Christopher W. Glanton, Tzu Cheg Kao, David Cruess, Lawrence Y.C. Agodoa, Kevin C. Abbott*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

185 Scopus citations

Abstract

Background. Cadaveric renal transplantation is associated with a survival advantage compared with dialysis patients remaining on the renal transplantation waiting list, but this advantage has not been confirmed in obese end-stage renal disease (ESRD) patients. Methods. Using data from the USRDS, we studied 7521 patients who presented with ESRD from 1 April 1995 to 29 June 1999 and later enrolled on the renal transplantation waiting list with body mass indices (BMI) ≥30 kg/m2 at the time of presentation to ESRD, and followed until 6 November 2000. Recipients of preemptive renal transplantation or organs other than kidneys were excluded. Cox non-proportional hazards regression models were used to calculate adjusted, time-dependent hazard ratios (HR) for time to death in a given patient during the study period, controlling for renal transplantation, demographics and comorbidities (Form 2728). Results. The incidence of mortality was 3.3 episodes per 100 patient-years (PY) in cadaveric renal transplantation and 1.9/100 PY in living donor renal transplantation compared with 6.6 episodes/100 PY in all patients on the transplant waiting list. In comparison to maintenance dialysis, both recipients of solitary cadaveric kidneys (HR 0.39, 95% CI 0.33 to 0.47), and recipients of living donor kidneys (HR 0.23, 95% CI 0.16 to 0.34) had statistically significant improved survival. A benefit of cadaveric renal transplantation did not apply to patients with BMI ≥41 kg/m2 (HR 0.47, 95% CI, 0.17 to 1.25, P = 0.13). Conclusions. Obese patients on the renal transplant waiting list had a significantly lower risk of mortality after renal transplantation compared with those remaining on dialysis.

Original languageEnglish
Pages (from-to)647-653
Number of pages7
JournalKidney International
Volume63
Issue number2
DOIs
StatePublished - 2003
Externally publishedYes

Keywords

  • Body mass index
  • Cadaveric organs
  • Dialysis
  • ESRD
  • Living donor
  • Obesity
  • Renal transplant
  • Survival
  • USRDS
  • Wait list

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