Background: Donor obesity has been reported as a risk factor for early pancreas allograft failure. The relationship between donor obesity and long-term pancreas allograft survival among patients receiving simultaneous pancreas and kidney transplantation (SPK) has not been well defined.

Methods: We performed a retrospective analysis using the United Network for Organ Sharing database, and examined 9916 SPKs between 2000 and 2013. Based on donor body mass index (DBMI), we categorized donors into BMI 20-25 (n=5724); 25-30 (n=3303); 30-35 (n= 751); and 35-50 (n= 138) kg/m2.

Results: Recipient characteristics of age, BMI, gender, race, hypertension, pre-transplant dialysis, time on the wait list, HLA mismatches, and PRA were similar between groups. Recipient co-morbidities such as peripheral and cerebrovascular disease and hypertension were similar between groups. Donor hypertension and death secondary to cerebral vascular accident were greater in the DBMI 35-50 Kg/m2 group. Kidney allografts from donors in the DBMI groups 30-35 and 35-50 kg/m2 were more likely to develop delayed graft function than DBMI group 20-25 Kg/m2. Adjusted multivariate Cox modeling demonstrated that organs from donors with a BMI of 35 to 50 kg/m2 were associated with greater pancreas (HR 1.42 [1.09-1.86], p=0.009) and kidney (HR 1.38 [1.04-1.85], p=0.026) allograft failure compared to a DBMI of 20-25kg/m2. DBMI of 30-35 kg/m2 did not increase risk of allograft failure (pancreas; HR 0.997 [0.86-1.15], p=0.97 or kidney; HR 1.03 [0.88-1.20], p=0.71).

Rates of pancreas and kidney allograft survival based on donor BMI

Conclusions: Donor BMI over 35 kg/m2 confers a worse kidney and pancreas allograft survival compared to DBMI 20-25 kg/m2. However, DBMI 30-35 Kg/m2 or lower confers similar survival probability compared to donors with BMI 20-25 kg/m2. This study suggests acceptance of pancreata from donors with BMI 30-35kg/m2 who are otherwise optimal can be considered and might expand the donor pool.

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