Objective: This study was performed to examine the suitability of transplantation in kidney transplant recipients (KTRs) with a high body mass index (BMI). Methods: In total, 370 consecutive KTRs stratified according to the World Health Organization BMI categories were retrospectively analysed. The estimated glomerular filtration rate (eGFR) was used to assess allograft function. Results: The mean BMI was 26.2 kg/m 2. Among all patients, 148 (40.0%) were pre-obese, 47 (12.7%) were class I obese, 11 (3.0%) were class II obese, and 9 (2.4%) were class III obese. A linear trend for male sex and younger age was observed from the normal BMI group through the progressively higher groups. Overweight and obese KTRs had a significantly higher incidence of pre-transplant diabetes, but there was no difference in post-transplant new-onset hyperglycaemia. Obesity was not a significant risk factor for a lower eGFR at the 1-year follow-up, but it became significant at the 2-and 3-year follow-ups. Graft loss occurred in 28 patients, and 25 patients died during follow-up. No difference in all-cause allograft loss was found among the different BMI groups during follow-up. Conclusion: Obesity affects the eGFR in the long term. Allograft survival was lower, but not significantly.

BackgroundThere is controversy regarding the suitability of high body mass index (BMI) candidates accessing the transplant waitlist.Patients and methodsObservational study on consecutive kidney transplant recipients undergoing surgery between January 2014 and March 2016 at our center. Patients were stratified according to BMI. Survival outcomes and graft function were analyzed to investigate the effect of donor’s and recipient’s demographic characteristics.Results396 kidney transplant recipients: 260 males, mean age 51.8 ± 15.9 years, followed up for a mean time of 5.86 ± 2.29 years. Mean BMI 26.2 ± 5.1. BMI class 1 (20 ≤ BMI ≤ 24.9) n=133, class 2 (25 ≤ BMI ≤ 29.9) n= 155, class 3 (30 ≤ BMI ≤34.9) n=53, class 4 (BMI ≥ 35) n=21, class V (BMI ≤ 19.9) n=34. Patient survival was not significantly different according to the recipient’s BMI class (p=0.476); graft survival was affected (p=0.031), as well as graft function up to 2 years post-transplant and at 4 years follow up (p=0.016). At logistic regression the factors independently associated with graft loss were only donor’s age (p=0.05) and BMI class of the recipient (p=0.002).ConclusionsObesity did not impact on patient’s survival but affected graft function and graft loss.