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Abstract: PO2531

Impact of High Body Mass Index on the Allograft Outcomes in Kidney Transplant Recipients with Presensitization to Human Leukocyte Antigen

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Chung, Byung ha, Seoul Saint Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)
  • Park, Yohan, Seoul Saint Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)
  • Lee, Hanbi, Seoul Saint Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)
  • Ko, Eun jeong, Seoul Saint Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)
  • Lee, Sua, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Ban, Tae Hyun, Eunpyeong Saint Mary's Hospital, Eunpyeong-gu, Seoul, Korea (the Republic of)
  • Min, Ji Won, Catholic University of Korea Bucheon Saint Mary's Hospital, Bucheon, Gyeonggi-do, Korea (the Republic of)
  • Yoon, Hye Eun, Catholic University of Korea Incheon Saint Mary's Hospital, Incheon, Incheon, Korea (the Republic of)
  • Yang, Chul Woo, Seoul Saint Mary's Hospital, Seocho-gu, Seoul, Korea (the Republic of)
Background

The aim of this study was to investigate whether high body mass index (BMI) and pre-sensitization to human leukocyte antigen (HLA) in kidney transplant recipients (KTR) had a synergistic impact on the allograft outcomes.

Methods

From January 2010 to December 2018, 1,290 KTs were performed in Seoul St Mary's Hospital. Of these, 682 cases of ABO compatible KT were enrolled. They were divided into 4 groups (low BMI-non-sensitized, high BMI-non-sensitized, low BMI sensitized, high BMI-sensitized) according to the median BMI value (22.7 kg/m2) and HLA pre-sensitization status (HLA-DSA MFI >3,000). Short-term and long-term allograft outcomes were compared between the groups.

Results

The rate of late antibody mediated rejection tended to be the highest in the high BMI-sensitized group, and the decline in allograft function in the high BMI-sensitized group was higher than in the other 3 groups. Death-censored graft loss (DCGL) rates and the hazard ratio (HR) for DCGL were the highest in the high BMI-sensitized group (4/21 (19.0%), HR 4.648, P = 0.022) and a significant interaction was detected between high BMI and HLA pre-sensitization status (P value for interaction = 0.008).

Conclusion

Our results suggest that pre-sensitization to HLA and high BMI in KTRs might have a synergistic adverse impact on the allograft outcomes.

Table 1. Hazard ratios of death-censored graft loss according to BMI and presensitization status
 Unadjusted HR (95% CI)P-valueAdjusted HR (95% CI)P-valueP-value for interaction
Low BMI-non sensitizedReference Reference 0.008
High BMI-non sensitized1.661 (0.849-3.247)0.1381.495 (0.735-3.041)0.267 
Low BMI-sensitized2.650 (0.872-8.057)0.0863.377 (1.082-10.538)0.036 
High BMI-sensitized5.656 (1.859-17.211)0.0024.648 (1.251-17.276)0.022 

Multivariate regression model was adjusted with parameters showing significant difference among the 4 groups according to BMI and pre-sensitization status. Parameters were as follows: Age, Sex, DM, HTN, Fasting glucose, Triglyceride, HDL-cholesterol, Hemoglobin A1c, ESRD causes, Dialysis modality, and Prior KT history.

Funding

  • Government Support - Non-U.S.