Background: Obesity rates in the transplant population are increasing. Previous studies are limited by small sample sizes, short-term follow up, and conflicting results. Factors including donor selection and recipient BMI could be optimized to improve outcomes.

Methods: Single center retrospective review of adult renal transplants from 1998-2013. Complications, graft and patient survival were calculated. Patients were classified according to BMI and donor type. Univariate and multivariate analysis were performed to determine independent risk factors for graft loss.

Results: 3,044 recipients were stratified by BMI (18-25 n= 975, 25.1-29.9 n=1067, 30-34.9 n=679, >35 n=323). There was no difference in the type of donation (DBD, DCD, LRD) between BMI groups (p=0.460) although patients with BMI>35 did receive a higher proportion of LRD than patients with BMI<35 (43.6% vs 38.8%). Post transplant, 5 and 10 year patient survival was significantly lower in patients with BMI>35 vs. BMI<35 (78.5% vs 85.9%, 58.3% vs 69.1%)(p<0.001). Likewise, 5 and 10 year death censored graft survival was significantly lower in patients with BMI>35 vs. BMI<35 (78.5% vs 86.5%, 62.9% vs 74.2%)(p=0.0014) . Multivariate analysis demonstrated BMI>35 (p<0.0001, HR 1.51), age>60 (p<0.0001, HR 1.80), DGF (HR 1.75, p<0.0001), KDPI>85 (HR 1.93, p<0.0001), and pre transplant T2DM (p<0.0001, HR 1.65) as independent risk factors for graft loss. Receiving a LRD kidney was protective (p=0.013, HR 0.84).

Conclusion: Patients with BMI>35 experience a higher rate of death, graft loss, and complications. Consideration of donor type, quality of deceased donor organs, and modification of pre transplant BMI are important factors to improve transplant outcome.

CITATION INFORMATION: Stahler P, Mezrich J, Leverson G, Kaufman D, Sollinger H. Renal Transplant in Obese Recipients: Consideration of Donor and Recipient Factors Can Improve Outcomes. Am J Transplant. 2016;16 (suppl 3).

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