Introduction: Kidney transplantation confers a survival benefit compared with dialysis in most studies of obese patients. Yet, many transplant centers decline patients with a body mass index (BMI) ≥40 kg/m2. Our practice relies on computed tomography imaging to evaluate iliac depth and pelvic angle to assess candidacy (see Figure 1). Our aim was to evaluate post-transplant outcomes including survival in patients according to recipient BMI. Methods: We performed a single-center retrospective review of adult kidney transplant alone recipients comparing BMI ≥40 patients (n=84, BMI =42±2 kg/m2) to a matched BMI <40 cohort (n=84, BMI =28±5 kg/m2). Patients were matched for recipient age, gender, race, presence of diabetes, and donor type (living vs. deceased). Results: BMI ≥40 patients were on dialysis longer pre-transplant (5.2±3.2 years vs. 4.1±3.5 years, p=0.03) and received lower kidney donor profile index (KDPI) kidneys (40±25% vs. 53±26%, p=0.003) compared to lower BMI patients. There were no significant differences in prevalence of delayed graft function, reoperations, readmissions, wound complications, patient survival, or renal function at 1 year according to serum creatinine and eGFR. Longterm graft survival was higher for BMI ≥40 patients, including after adjusting for KDPI (BMI ≥40: aHR=1.79, 95% CI=1.09-2.9) (see Figure 2). BMI ≥40 patients had similar weight gain and BMI change in the first year post-transplant (delta weight: BMI ≥40 + 2.5±9.1 kg vs. BMI <40 + 3.0±8.0 kg, p=0.74; delta BMI: BMI ≥40 + 0.9±3.3 vs. BMI <40 + 1.1±3.2, p=0.59). BMI ≥40 patients had a higher mean HbA1c level (6.9±1.7% vs. 5.9±1.4%, p=0.003) at one year post-transplant. Conclusions: Overall patient survival and complications after kidney transplantation were comparable in BMI ≥40 patients compared to a matched cohort with lower BMI with improved long-term graft survival in the obese patients. BMI-based exclusion criteria for kidney transplantation should be reexamined in favor of a more individualized approach.

Introduction: There are dearth of knowledge for the follow-up studies with regards to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in kidney transplant recipients (KTR). We have previously reported first such report of a small cohort. Herein we analyse long term outcome of COVID-19 infection in KTR across different pandemic waves including delta and omicron wave. Methods: We conducted this retrospective, single center cohort study of hospitalized (n = 367) and non-hospitalized KTR (n = 197) for a median (range) follow-up of 14 (1-20) months who recovered from SARS-CoV-2 during May 2020 to Jan 2022. All confirmed RT-PCR cases with at least 3-month followup were included. The outcomes measured were persistent symptoms postdischarge; EuroQoL visual analogue score (EQ-VAS); EuroQoL 5-dimension score (E5-QD-5L) score and modified medical research dyspnea score (mMRC) at discharge, 3 months and last follow-up. Other outcomes were graft outcome and postulated COVID-19 sequelae. Results: The median(range) age of the cohort was 44 (15-71) years and COVID-19 severity ranged from asymptomatic (14%), mild (40%), moderate (36%) to severe (10%). The most common persistent symptom was generalized which significantly decreased in the follow-up (n = 110 vs. 53 vs. 11]; p-value = 0.0001) at discharge, 3-month, and last follow-up respectively. Decrement in the mean (standard deviation) EQ-VAS score from baseline was also improved (36 [13] vs. 17 [12.5] vs. 8 [12.0]; p-value < 0.0001). There was statistically significant improvement in all EQ-5D-5L scores in follow-up. There was no deterioration in mMRC scores during the follow-up Moderatesevere cases had significantly poorer overall scores initially, but there was no difference at long term follow-up. 27 of 30 graft losses reported had baseline chronic graft dysfunction at baseline. There were no unexplained deaths, pulmonary fibrosis, cardiovascular event or cerebrovascular event. Conclusion:We report the largest cohort of Indian transplant recipients with COVID-19 at longest follow-up. Improvement in quality of life and no postulated COVID-19 sequelae ensures that no residual abnormality exist in post-COVID-19 KTR.