Kidney Week

Abstract: TH-PO990

The Impact of Donor BMI on Outcomes after Deceased Kidney Transplantation

Session Information

• Transplant Recipient Education, Adherence, and Novel Risk Factors for Graft Loss
  November 02, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Transplantation

• 1702 Transplantation: Clinical and Translational

Authors

• Arshad, Adam, University of Birmingham, Stoke on Trent, United Kingdom

Adam Arshad,

• Chappelow, Imogen, University of Birmingham, Stoke on Trent, United Kingdom

Imogen Chappelow,

• Hodson, James, Biostatistics , Birmingham, United Kingdom

James Hodson,

• Ready, Andrew, University Hospital BIrmingham, Birmingham, United Kingdom

Andrew Ready,

• Nath, Jay, University Hospital Birmingham, Birmingham, United Kingdom

Jay Nath,

• Sharif, Adnan, Queen Elizabeth Hospital, Birmingham, Birmingham, United Kingdom

Adnan Sharif,

Background

The shortage of available donor organs means we must reconsider our current policies on donor selection. There is variation in practice between centers as to the acceptable limit to donor BMI in deceased kidney transplantation, with no recommendations in American or UK guidelines.

Methods

Data from the UK National Health Service Blood and Transplantation register was analysed for all patients receiving deceased donor kidney transplants (Jan 2003 - Jan 2015). Transplants were separated into 5 categories depending on the donor’s body mass index (BMI) (kg/m²): < 18.50 (underweight), 18.50 – 25.00 (normal), 25.01 – 30.00 (overweight), 30.01 – 35.00 (obese) and > 35.00 (morbidly obese). Risk-adjusted outcomes were assessed by multivariable analysis, adjusting for donor, recipient and peri-operative characteristics.

Results

Data for 17,590 transplants were assessed (donor BMI < 18.50 kg/m² in 380, 18.50 kg/m² – 25.00 kg/m² in 6890, 25.01 kg/m² – 30.00 kg/m² in 6692, 30.01 kg/m² – 35.00 kg/m² in 2503 and > 35.00 kg/m² in 1148). On multivariable analyses, increasing donor BMI was found to be an independent risk factor for delayed graft function (p<0.001), with rates of 27.8%, 31.4% and 32.8% for normal, obese and morbidly obese patients, respectively. However, no evidence of significant differences in longer term outcomes such as patient survival (p= 0.109), graft survival (p= 0.093) or 12-month creatinine values (p= 0.550) were detected between donor BMI groups.

A subgroup analysis of DCD recipients was performed (n = 3593). Whilst increasing donor BMI was found to be associated with an increase the functional warm ischaemia time (WIT) and standard WIT by an average 1.80 (p = 0.030) and 2.19 minutes (p = 0.015) respectively, this was not found to have a significant impact on the incidence of delayed graft function (p= 0.464, p= 0.520) or graft survival (p= 0.760, p = 0.423) on multivariable analysis.

Conclusion

In this large national cohort study, we found that there was no evidence of significant differences in long-term outcomes between deceased donor kidneys from different BMI groups. Rejection of kidneys based upon donor BMI alone does not appear to be justified.