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Normothermic Ex Vivo Kidney Perfusion for the Preservation of Kidney Grafts prior to Transplantation
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Body Mass Index and Early Graft Function After Pediatric Kidney Transplantation

Ayham Asassfeh1, Emre Arpali1, Emily Cooper2

  • 1Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.

Pediatric Transplantation
|February 10, 2026
PubMed

Insights

Higher body mass index (BMI) is linked to increased odds of early graft dysfunction in pediatric kidney transplant recipients. This study found a progressive increase in delayed graft function (DGF) and slow graft function (SGF) with higher BMI categories.

Area of Science:

  • Pediatric Nephrology
  • Transplantation Immunology
  • Clinical Nutrition

Background:

  • Nutritional status significantly impacts outcomes in pediatric kidney transplantation.
  • Previous studies show inconsistent associations between body mass index (BMI) and early graft function in children, creating uncertainty.

Purpose of the Study:

  • To investigate the association between BMI and early graft dysfunction in pediatric kidney transplant recipients.
  • To clarify the relationship between varying BMI categories and outcomes like delayed graft function (DGF), slow graft function (SGF), and hospital length of stay (HLOS).

Main Methods:

  • Analysis of pediatric kidney-only recipients from the Organ Procurement and Transplantation Network (OPTN) registry.
  • Exclusion of recipients with specific criteria (e.g., age < 2 years, multi-organ transplants). BMI classified using CDC growth charts.
  • Outcomes assessed included DGF, SGF, and HLOS, with statistical analyses using logistic and linear regression.

Main Results:

  • A cohort of 9098 recipients was analyzed, showing an increasing incidence of DGF across BMI groups (3.9% underweight to 5.9% obese).
  • Higher BMI categories were significantly associated with increased odds of DGF (OR 1.16) and SGF (OR 1.20).
  • Hospital length of stay was modestly longer in higher BMI groups (median 9 vs. 8 days).

Conclusions:

  • Elevated BMI is associated with modest differences in early graft dysfunction following pediatric kidney transplantation.
  • Trend analyses reveal a graded relationship between BMI and the incidence of DGF and SGF, although absolute differences are small.
Abstract

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