Is big bad or bearable? Long-term renal transplant outcomes in obese recipients

BACKGROUND: The global obesity epidemic has implications for kidney transplantation. There are conflicting reports regarding the impact of obesity on long-term post-transplant outcomes. AIM: To explore the impact of body mass index (BMI) on long-term outcomes after kidney transplantation. DESIGN: The association between BMI and cardiovascular disease, cancer, post-transplant diabetes mellitus, graft and recipient survival was investigated in recipients who had been transplanted at least ten years previously. METHODS: All consecutive adult renal transplant recipients who received first, deceased donor, transplants between 1986 and 2005 in Northern Ireland were followed-up until 2016. RESULTS: A total of 328 patients were eligible. Of them, 96 were overweight with a BMI 25.0-29.9 kg/m2, and 56 were obese with a BMI exceeding 29.9 kg/m2. Median follow-up time was 16.7 years. In multivariate analysis recipient BMI was associated with the development of post-transplant diabetes mellitus (P=0.003), but not with new cardiovascular disease (P=0.78). Cancer was less common in recipients with a higher BMI (hazard ratio (HR) 0.58, P