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Investigating the controversial link between pediatric obesity and graft survival in kidney transplantation
Brooke Stanicki1, Dante A Puntiel1, Benjamin Peticca1
1Department of Surgery, Temple University Hospital, Philadelphia, PA 19140, United States.
Insights
Severe obesity and underweight status negatively impact kidney transplant outcomes in children. Higher body mass index (BMI) categories correlate with increased graft failure and mortality risks, highlighting the need for tailored transplant criteria.
Area of Science:
- Pediatric Nephrology
- Transplant Surgery
- Public Health
Background:
- Childhood obesity is a growing public health issue, especially for children with chronic kidney disease awaiting kidney transplant (KT).
- Obesity is common in this population and linked to disease progression, yet its effect on pediatric KT outcomes is not well understood.
- This study addresses the gap in knowledge regarding body mass index (BMI) classifications and their impact on pediatric KT success.
Purpose of the Study:
- To determine the influence of different body mass index (BMI) classifications on graft and patient survival rates after pediatric kidney transplant (KT).
- To analyze the association between BMI categories and key transplant outcomes in a large cohort of pediatric KT recipients.
Main Methods:
- A retrospective cohort study utilized data from 23,081 pediatric kidney transplant (KT) recipients from 1987 to 2022.
- Patients were categorized into six BMI groups: underweight, healthy weight, overweight, and Class 1, 2, or 3 obesity.
- Statistical analyses included ANOVA, Kruskal-Wallis, Chi-squared tests, Kaplan-Meier survival analysis, and Cox proportional hazard regressions.
Main Results:
- Class 3 obesity was associated with lower 1-year graft survival (88.7%) compared to healthy weight (93.1%).
- Underweight recipients showed reduced 10-year patient survival (81.3%), while Class 2 and 3 obesity had the lowest 5-year graft survival rates.
- Increased BMI category independently predicted graft failure (HR=1.091) and mortality (HR=1.079), with obese patients experiencing longer cold ischemia times.
Conclusions:
- Both severe obesity and underweight status are linked to worse long-term outcomes in pediatric kidney transplant (KT) recipients.
- Findings suggest a need for refined transplant eligibility criteria that account for obesity-related risks and socioeconomic factors.
- Addressing BMI disparities is crucial for improving graft and patient survival in pediatric KT.
Background:
Childhood obesity is a significant public health concern, particularly amongst children with chronic kidney disease requiring kidney transplant (KT). Obesity, defined as a body mass index (BMI) of 30 kg/m² or greater, is prevalent in this population and is associated with disease progression. While BMI influences adult KT eligibility, its impact on pediatric transplant outcomes remains unclear. This study investigates the effect of BMI on graft survival and patient outcomes, addressing gaps in the literature and examining disparities across BMI classifications.
Aim:
To assess the impact of BMI classifications on graft and patient survival following KT.
Methods:
A retrospective cohort study analyzed 23081 pediatric transplant recipients from the Standard Transplant Analysis and Research database (1987-2022). Patients were grouped into six BMI categories: Underweight, healthy weight, overweight, and Class 1, 2, and 3 obesity. Data were analyzed using one-way way analysis of variance, Kruskal-Wallis tests, Chi-squared tests, Kaplan-Meier survival analysis with log-rank tests, and Cox proportional hazard regressions. Statistical significance was set at P < 0.05.
Results:
Class 3 obese recipients had lower 1-year graft survival (88.7%) compared to healthy-weight recipients (93.1%, P = 0.012). Underweight recipients had lower 10-year patient survival (81.3%, P < 0.05) than healthy-weight recipients. Class 2 and 3 obese recipients had the lowest 5-year graft survival (67.8% and 68.3%, P = 0.013) and Class 2 obesity had the lowest 10-year graft survival (40.7%). Cox regression identified increases in BMI category as an independent predictor of graft failure [hazard ratio (HR) = 1.091, P < 0.001] and mortality (HR = 1.079, P = 0.008). Obese patients experienced longer cold ischemia times (11.6 and 13.1 hours vs 10.2 hours, P < 0.001). Class 3 obesity had the highest proportion of Black recipients (26.2% vs 17.9%, P < 0.001).
Conclusion:
Severe obesity and underweight status are associated with poorer long-term outcomes in pediatric KT recipients, emphasizing the need for nuanced transplant eligibility criteria addressing obesity-related risks and socioeconomic disparities.
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