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22.08.2018 | Original Article | Ausgabe 12/2018

Pediatric Nephrology 12/2018

Outcomes of underweight, overweight, and obese pediatric kidney transplant recipients

Zeitschrift:
Pediatric Nephrology > Ausgabe 12/2018
Autoren:
Kiranjot Kaur, Daniel Jun, Elliot Grodstein, Pamela Singer, Laura Castellanos, Lewis Teperman, Ernesto Molmenti, Ahmed Fahmy, Rachel Frank, Lulette Infante, Christine B. Sethna
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00467-018-4038-8) contains supplementary material, which is available to authorized users.
Kiranjot Kaur and Daniel Jun are Co-first Authors

Abstract

Background

Obesity is a risk factor for poor transplant outcomes in the adult population. The effect of pre-transplant weight on pediatric kidney transplantation is conflicting in the existing literature.

Methods

Data was collected from the Organ Procurement and Transplantation Network (OPTN) database on recipients aged 2–21 years who received a kidney-only transplant from 1987 to 2017. Recipients were categorized into underweight, normal, overweight, and obese cohorts. Using adjusted regression models, the relationship between recipient weight and various graft outcomes (delayed graft function [DGF], acute rejection, prolonged hospitalization, graft failure, mortality) was examined.

Results

18,261 transplant recipients (mean age 14.1 ± 5.5 years) were included, of which 8.7% were underweight, 14.8% were overweight, and 15% were obese. Obesity was associated with greater odds of DGF (OR 1.3 95% CI 1.13–1.49, p < 0.001), acute rejection (OR 1.23 95% CI 1.06–1.43, p < 0.01), and prolonged hospitalization (OR 1.35 95% CI 1.17–1.54, p < 0.001) as well as greater hazard of graft failure (HR 1.13 95% CI 1.05–1.22, p = 0.001) and mortality (HR 1.19 95% CI 1.05–1.35, p < 0.01). The overweight cohort had an increased risk of graft failure (HR 1.08 95% CI 1.001–1.16, p = 0.048) and increased odds of DGF (OR 1.2 95% CI 1.04–1.38, p = 0.01) and acute rejection (OR 1.18 95% CI 1.01–1.38, p = 0.04). When stratified by age group, the increased risk was realized among younger and older age groups for obese and overweight. Underweight had lower risk of 1-year graft failure (HR 0.82 95% CI 0.71–0.94, p < 0.01), overall graft failure in the 13–17-yr. age group (HR 0.84 95% CI 0.72–0.99, p = 0.03) and acute rejection in the 2–5-yr. age group (OR 0.24 95% CI 0.09–0.66, p < 0.01).

Conclusion

Pre-transplant weight status and age impact pediatric kidney transplant outcomes. Recipient underweight status seems to be protective against adverse outcomes while overweight and obesity may lead to poorer graft and patient outcomes.

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