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Updated: Sep 10, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Overweight and Obesity in Pediatric Kidney Transplant Recipients Are Not Associated With Higher Risks of Early
Juliane Richter1,2, Fabian Doktor3,4, Mandy Rickard1
1Division of Urology, the Hospital for Sick Children and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Insights
Overweight and obese children undergoing kidney transplants show no increased risk of short-term complications. These findings suggest that elevated body mass index should not exclude pediatric patients from kidney transplantation.
Area of Science:
- Pediatric Nephrology
- Transplantation Surgery
- Obesity Research
Background:
- Childhood overweight and obesity are potential risk factors for complications in pediatric kidney transplantation.
- Previous hypotheses suggested worse outcomes for obese pediatric kidney transplant recipients.
- This study investigates short-term complications in relation to body mass index (BMI) percentiles.
Purpose of the Study:
- To determine if pediatric kidney transplant patients with elevated BMI (above the 85th percentile) face higher risks of short-term postoperative complications.
- To compare outcomes between normal weight and overweight/obese pediatric kidney transplant recipients.
Main Methods:
- Retrospective review of a pediatric kidney transplant database (2010-2020).
- Patients aged 2-18 years were categorized by BMI percentile (normal: 5th-85th; overweight/obese: >85th).
- Propensity score matching (1:2 ratio) adjusted for diagnosis, sex, and age; Clavien-Dindo classification for complications.
Main Results:
- No significant difference in overall postoperative complications between normal weight and overweight/obese groups (p=0.42).
- Similar rates of graft rejection and creatinine levels at multiple time points post-transplant.
- Overweight/obese patients required more intraoperative blood transfusions (p=0.006) and had longer hospital stays (p=0.02).
Conclusions:
- Overweight and obesity do not appear to increase short-term postoperative complications in pediatric kidney transplant recipients.
- Elevated BMI should not be a contraindication for pediatric kidney transplantation.
- Further research may explore long-term outcomes and specific management strategies for overweight/obese pediatric transplant patients.
Background:
Childhood overweight and obesity have been hypothesized to pose challenges in pediatric kidney transplantation due to potential complications and resultant worse outcomes. Herein, we aimed to determine if pediatric patients with an elevated body mass index (BMI) (> 85th percentile) are at higher risk for short-term complications following kidney transplantation.
Methods:
Following a review of our transplant database (2010-2020), patients > 2-18 years were assigned to groups based on BMI percentiles at the time of surgery: normal (5th-85th percentile; n = 120) and obese/overweight (> 85th percentile; n = 60). Patients were matched using a 1-to-2-ratio nearest-neighbor propensity score matching adjusting for underlying diagnosis, sex, and age. The primary outcome was postoperative complications classified according to Clavien-Dindo, and secondary outcomes included postoperative creatinine and kidney graft rejection.
Results:
One hundred eighty patients (n = 120 in the control and n = 60 in the overweight and obese group) were included. There was no significant difference in postoperative complications (72/120 vs. 40/60, p = 0.42). We noted no difference in nadir creatinine (7 days, [interquartile range (IQR) 1, 679] and 9 days, [IQR 1, 690], p = 0.11), postoperative creatinine levels at 3-, 6-, and 12-months post-transplantation, or rejection rates (8.4% and 8.4%, p > 0.99) between normal weighed and obese/overweight patients. However, more overweight and obese patients required intraoperative blood transfusions (55% and 33.4%, p = 0.006) and longer hospital stays (18.0 [IQR 9, 133] and 15.0 [IQR 7, 49], p = 0.02).
Conclusions:
It appears as though overweight and obese pediatric kidney transplant patients do not experience more postoperative complications. We propose that overweight and obesity should not be considered criteria to exclude pediatric patients from undergoing kidney transplantations.
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