It is known that obese wait-listed patients are less likely to undergo deceased donor transplantation compared to non-obese patients. Using Cox multivariate regression analyses and data from the USRDS we determined the association of body mass index (BMI) with access to living donor transplantation among n =703,097 incident ESRD patients aged 18-70 years after adjustment for differences in age, gender, race, cause of ESRD, and comorbid conditions. The table shows patients with BMI < 18.5kg/m² and > 35.0kg/m² had a lower likelihood of living donor transplantation than normal weight patients (BMI 24.5-29.9 kg/m²). Analyses stratified by gender (Table) showed that the impact of BMI on access to transplantation differed between males and females: There was a progressively lower likelihood of living donor transplantation with increasing BMI among females; however among males, BMI was not associated with a lower likelihood of living donor transplantation until the BMI ≥ 40 kg/m².

These results were consistent in a sub-group analysis restricted to (N=105,792) patients who were activated to the deceased donor waiting list with one year of dialysis initiation (data not shown). In a multivariate Cox regression model, higher BMI was associated with an incresed risk of living donor transplant failure, but the obesity associated risk of living donor transplant failure was similar between males and females (p>0.05 for interaction of BMI X gender). We conclude that obesity is associated with a decreased access to living donor transplantation primarily among women, despite no differential impact of obesity on allograft survial in men and women.

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