*Purpose: Weight gain is a significant issue in the post-transplant period and can contribute to morbidity and development or worsening of diabetes and hypertension. Some studies suggest that weight gain is greatest in the first six months following transplantation but long-term follow and associated factors in a food insecure population have not been studied.

*Methods: A random convenience sample of 28 KTRs was interviewed via face-to-face survey in an inner-city outpatient transplant clinic. Chart review was conducted by retrospective examination of electronic health records. Stress and anxiety were measured using validated questionnaires (PSS and PHQ9). 24-hour food recall was analyzed using ASA24 software. Values for macronutrients and minerals were used to calculate HEI (Healthy Eating Index) scores. Scores range from 0 to 100 reflecting how closely diet allies with recommendations for healthy adults. The average HEI in the US is 59, which is considered poor adherence.

*Results: Mean age of the population was 55.6+/-13.7 yrs. There were 18 men (64.3%) and 10 women (35.7%). 82% were black, 32% had completed college, and 75% had a household income <$40k/yr. Initial BMI was 26.8+/-7.3, last follow up BMI was 27.5+/-5.6 and creatinine was 2.32+/-2.0. 14 (50%) of patients had an increase in BMI of >10% from initial weight. Mean time since transplant was 6.6+/-7.8 yrs. 60% of patients had >5% weight change within the first 6 months post-transplant with 53.6% of patients gaining 7 pounds or more. More patients that participated in food programs and got SNAP/EBT gained post-transplant than those who did not (X²= 3.884, p=0.049). Weight gain at 6 months correlated with presence of diabetes at time of transplant (r=-.611, p<0.005) and lower HEI score (r=-.460, p<0.05). 18 (65%) patients had a BMI>25 at last follow up. By t-test, patients in this group scored significantly higher on both the PHQ9 (5.12+/-5.0 vs 1.56+/-1.2, p<0.05) and the PSS (11.4+/-6.8 vs 5.6+/-4.7, p<0.001) than pts with BMI<25.

*Conclusions: In our population of inner-City transplant recipients: 1. Significant weight gain at 6 months did not remit by last follow up and was common problem, with 50% experiencing a 10% gain in BMI. 2. Lower HEI score was associated with greater weight gain and for our whole population fell below national average, suggesting patients overall have poor dietary habits. 3. Patients receiving SNAP/EBT support were more likely to gain weight post-transplant. 4. Patients who met the criteria for obesity at last follow up scored significantly higher on both measures of depression and anxiety. 5. The interplay of stress/anxiety, poor diet quality and financial stressors with obesity and weight gain in indigent kidney transplant populations should be further examined so that intervention strategies can be tailored to this particular population.

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