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Updated: Apr 28, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Effects of obesity on kidney transplantation outcomes: a systematic review and meta-analysis
Bruna B Nicoletto1, Natasha K O Fonseca, Roberto C Manfro
11 Post Graduation Medical Sciences Program, Endocrinology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 2 Nutrition Course, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 3 Post Graduation Medicine Program, Medical Sciences, School of Medicine, Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 4 Division of Nephrology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 5 Post Graduation Medical Sciences Program, Endocrinology, School of Medicine, Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 6 Division of Endocrinology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 7 Nutrition Course, School of Medicine, Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 8 Address correspondence to: Gabriela Corrêa Souza, Ph.D., Hospital de Clínicas de Porto Alegre, 2350 Ramiro Barcelos St, Bldg 12, 2nd Floor, Room 12201, ZIP code 90035-903, Porto Alegre, Brazil.
Background:
The effects of obesity on outcomes reported after kidney transplantation have been controversial. The purpose of this systematic review and meta-analysis was to elucidate this issue.
Methods:
MEDLINE, EMBASE, Cochrane Library, and gray literature were searched up to August 6, 2013. Studies that compared obese and nonobese patients who underwent kidney transplantation and evaluated one of these outcomes-delayed graft function (DGF), acute rejection, graft or patient survival at 1 or 5 years after transplantation, or death by cardiovascular disease (CVD)-were included. Two independent reviewers extracted the data and assessed the quality of the studies.
Results:
From 1,973 articles retrieved, 21 studies (9,296 patients) were included. Obesity was associated with DGF (relative risk, 1.41; 95% confidence interval, 1.26-1.57; I=8%; Pheterogeneity=0.36), but not with acute rejection. Graft loss and death were associated with obesity only in the analysis of studies that evaluated patients who received a kidney graft before year 2000. No association of obesity with graft loss and death was found in the analysis of studies that evaluated patients who received a kidney graft after year 2000. Death by CVD was associated with obesity (relative risk, 2.07; 95% confidence interval, 1.17-3.64; I=0%; Pheterogeneity=0.59); however, most studies included in this analysis evaluated patients who received a kidney graft after year 2000.
Conclusion:
In conclusion, obese patients have increased risk for DGF. In the past years, obesity was a risk factor for graft loss, death by CVD, and all-cause mortality. However, for the obese transplanted patient today, the graft and patient survival is the same as that of the nonobese patient.
