Obesity has been associated with an increased risk of allograft loss and death from infection in kidney transplant recipients (KTRs). Therefore, previous studies suggested bariatric surgery in KTRs (KTRs) prior to transplantation.

Here, we studied all KTRs at our center between 2005 and 2012. 29 (4%), 317 (48%), 217 (33%), 76 (12%), and 21 KTRs (4%) were identified as underweight, normal-weight, overweight, obese, and morbid obese, respectively. 33 of 97 KTRs (34%) with obesity had pre-existing diabetes. A control of normal-weight KTRs with/without diabetes was used for comparison. Samples were collected before transplantation and at +1, +2, +3 months posttransplantation. Alloreactive T-cells were measured using an interferon-γ Elispot assay.

Upon multivariate analysis obese KTRs showed an increased incidence of pre-existing diabetes and delayed allograft function (p<0.05). KTRs with morbid obesity showed significantly decreased patient survival (p<0.001), whereas no differences were observed for allograft survival (p=0.545). Among obese KTRs, those with diabetes showed decreased patient and allograft survial, higher rates of infection and delayed graft function (p<0.05). Interestingly, no differences were observed between obese KTRs without diabetes and normal-weight KTRs with/without diabetes (p>0.05). Obese KTRs with diabetes showed significantly higher incidences of alloreactive T-cells prior to transplantation compared to obese KTRs without diabetes or normal-weight KTRs (p<0.05).

Our results suggest that the increased risk for allograft loss and death from infection in obese KTRs is limited to those with diabetes. A state of obesity-related inflammation plus hyperglycemia may trigger increased alloreactivity in obesity and should call for adequate immunosuppression.

CITATION INFORMATION: Schachtner T, Stein M, Reinke P. Diabetes Mellitus Predicts Outcome in Obesity After Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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