MO984IMPACT OF RECIPIENT BODY MASS INDEX ON KIDNEY TRANSPLANTATION OUTCOME: A SINGLE CENTER EXPERIENCE
Authors: Sadek Nermin , Fouad Mohamed , Wafa Ehab , Salah Ahmed Mohamed 
Published: May 2021

Abstract

Background and Aims
Kidney transplantation is the best treatment modality for ESRD patients. Obesity is not considered a contraindication for kidney transplantation. However, impact of obesity on the recipient after transplantation is considered a point of interest due to high metabolic complications associated with both transplantation and obesity.
Our aim is to evaluate the effect of obesity on kidney transplant recipients regarding metabolic derangement, early surgical complications, and patient and graft survival.

Method
This retrospective, cohort study was performed in Mansoura Urology and Nephrology Center, Egypt and it included 460 kidney transplant recipients (KTRs) who underwent renal transplantation from living donors between March 1976 and December 2015 with age ranged from 19 to 55 years who were divided into 3 groups according to their BMI at time of transplantation: Group I: normal (BMI&lt;25, 230 KTRs), Group II: overweight (BMI 25-30, 70 KTRs), Group III: Obese (BMI &gt;30, 160 KTRs). The 3 groups were compared regarding baseline characteristics, transplantation data, post-transplantation medical, surgical complications, graft outcome, graft and patient survival.

Results
Baseline demographic data regarding age, sex of both recipients and donors and immunologic data were comparable. Pre-transplant hypertension and hypercholesterolemia was higher among obese and over-weight patients (p value: 0.003, 0.0001). While, incidence of diabetes, ischemic heart disease and hyperuricaemia was comparable.
Ischemia time was comparable but time to diuresis was delayed among over-weight group with statistical significant difference (p value: 0.012). No statistical significant difference regarding either induction or maintenance therapy.
Obese group had the highest incidence of rejection episodes. The difference has statistical significance (p value&lt; 0.029). Also, the number of rejection episodes was higher among obese and over-weight groups than normal-weight group (p value&lt; 0.006).
Incidence of post-transplant hypertension, diabetes and trans-aminitis was more prevalent among obese and over-weight groups (p value&lt; 0.035, 0.0001 and 0.003 respectively). Also, ischemic heart disease and hyperuricemia incidence higher prevalence among over-weight (p value&lt; 0.048 and 0.03 respectively). 57.2% of over-weight and 70.1% of obese patients were controlled for hypertension by more than 1 drug while 73.3% of normal weight patients were controlled by 1 drug (p value: 0.012). Higher percent of obese patients required insulin for diabetic control (p value: 0.001).
Lymphocele and wound dehiscence incidence was more frequent among obese and over-weight groups (p value&lt;0.001, 0003).
Serum creatinine levels after 1, 2 and 3 years were higher in obese group (p value&lt; 0.035, 0.0001 and 0.003). At last follow-up, serum creatinine and creatinine clearance were comparable. Five, 10 and 15 years graft and patient survival were comparable among the studied groups with no statistical significant difference.

Conclusion
Metabolic complications of transplantation were exaggerated by obesity. Higher BMI at time of transplantation is associated with higher incidence and difficult control of hypertension, diabetes and surgical complications. Obese patients were controlled by higher doses and additional medications for hypertension and diabetes. Overall graft and patient survival were not affected.