The purpose of this study was to determine the association of nutritional markers at the time of kidney transplant failure, and changes in these parameters during the period of allograft function with death after transplant failure.

Adult first transplant recipients n = 7,820 in the USRDS between 1995-2007 who started chronic dialysis after transplant failure and who had two Medevid forms available for analysis (one at first ESRD treatment, and one at time of dialysis initiation after transplant failure) were studied.

Multivariate Cox regression models were used to determine the association of BMI, serum albumin, and pre-dialysis serum creatinine (SCr) (a marker of muscle mass), and changes in these parameters during the period of transplant function, with death after transplant failure.

At time of transplant failure, obese patients (BMI ≥30, HR 0.83,(0.74-0.92)) had a lower risk of death compared to normal weight patients (BMI 18.5-24.9, reference group). However, obesity at transplant failure was not protective in those who gained weight during the period of allograft function. Overweight patients (BMI 25.0-29.9, HR 0.86, (0.78-0.94)) also had a reduced risk of death, but weight changes during tranplant function were not associated with death in this group. Underweight patients (BMI<18.5) had a similar risk of death compared to normal weight patients (HR 1.06,(0.92-1.24)) but were at increased risk of death if they had lost weight during the period of transplant function.

Serum albumin <4.0 at transplant failure was associated with an increased risk of death (albumin < 3.0, HR 1.50 (1.28,1.75); albumin 3.0-3.49, HR 1.24 (1.07,1.45); albumin 3.5-3.99 HR 1.18 (1.02,1.37), but patients with a drop in albumin during the period of transplant function were not at additional risk.

Compared to patients in the highest quintile of SCr at time of transplant failure (Q5 SCr >11.8 mg/dl), patients in the lowest quintile (SCr < 5.8 mg/dl) were at increased risk of death HR 1.22 (1.05, 1.41). However, patients with pre-dialysis SCr in Q2,Q3,Q4 were not at increased risk of death. There was no association between a drop in SCr during the period of transplant function and death after transplant failure.

Conclusion: BMI, serum albumin and pre-dialysis SCr are associated with death after transplant failure. A change in weight during the period of transplant function, modifes the association of BMI with death after transplant failure in underweigtht and obese patients.

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