The Survival Benefit of Kidney Transplantation in Obese Patients

Obese patients have a decreased risk of death on dialysis but an increased risk of death after transplantation, and may derive a lower survival benefit from transplantation. Using data from the United States between 1995 and 2007 and multivariate non-proportional hazards analyses we determined the relative risk of death in transplant recipients grouped by body mass index (BMI) compared to wait-listed candidates with the same BMI (n = 208 498). One year after transplantation the survival benefit of transplantation varied by BMI: Standard criteria donor transplantation was associated with a 48% reduction in the risk of death in patients with BMI = 40 kg/m 2 but a = 66% reduction in patients with BMI < 40 kg/m 2. Living donor transplantation was associated with = 66% reduction in the risk of death in all BMI groups. In sub-group analyses, transplantation from any donor source was associated with a survival benefit in obese patients = 50 years, and diabetic patients, but a survival benefit was not demonstrated in Black patients with BMI = 40 kg/m 2. Although most obese patients selected for transplantation derive a survival benefit, the benefit is lower when BMI is = 40 kg/m 2, and uncertain in Black patients with BMI = 40 kg/m(2)