Abstract: TH-PO773
Kidney Transplant Outcomes in Patients with BMI of 35 or Greater: Should We Be Doing More? A Single-Center Experience
Session Information
- Transplantation: Clinical - 1
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Sabharwal, Arjun, Northern General Hospital Sheffield Kidney Institute, Sheffield, South Yorkshire, United Kingdom
- Khwaja, Arif, Northern General Hospital Sheffield Kidney Institute, Sheffield, South Yorkshire, United Kingdom
- Whatmore, Jacob William, Northern General Hospital Sheffield Kidney Institute, Sheffield, South Yorkshire, United Kingdom
Background
Obesity remains a key barrier to access to kidney transplantation. Large registry data shows that whilst obese patients have poorer graft survival compared to those with a normal BMI, they still have a survival advantage when compared to outcomes on dialysis. However, it is not clear whether there are similar outcomes in smaller transplant centers. We therefore conducted a single-center audit evaluating transplant outcomes in patients with BMI ≥ 35 at the time of transplant at the Sheffield Kidney Institute, UK from 2010-2023.
Methods
This single center, retrospective study looked at death censored graft survival, medical and surgical complications for a total of 53 patients who were transplanted from 2010 to 2023 with a BMI ≥ 35 kg/m2 at the time of transplant.
Results
A total of 53 transplants were done in the time period in patients with a BMI ≥ 35. The recipient mean age was 58 years (SD 10.7) with a mean BMI of 36.8 kg/m2 (Range: 35-40.9) at the time of transplant. Most common primary disease was IgA Nephropathy(n=11) followed by Diabetic Nephropathy (n=8). Graft failure was observed in 10 patients (18.8%) and 13 (24.6%) died with a functioning graft out of a total 53 transplants. In the 38 patients who had at least 5 years follow up, 23 ( 60.6%) had a functioning graft and there were 6 graft failures (15.8%) over a median follow up of 6.29 years. Average eGFR for those with functioning grafts were 53.9 ml/min/1.73m2 with a mean graft survival age of 6.8 years. In terms of medical complications 6 (11.3%) had a biopsy proved rejection , 28 (52.8%) had a delayed graft function, post-transplant CMV was seen in 3 patients. New onset diabetes after transplant was observed in 11(28.9%) patients. Six % of grafts failed in the first 3 months. Wound infection was the most common surgical complication n=8 (15.1%) and the average length of stay in hospital was 7.8 days. Readmission rates within 30 days were n=11(20.7%).
Conclusion
Patients with BMI ≥ 35 do have increased medical and surgical complications including NODAT, delayed graft function and wound infection but can be successfully transplanted. Careful patient selection and optimisation may further improve transplant in obese recipients. Patients in smaller centres should not be denied transplantation based on BMI alone and a thorough assessment by the surgeon should be done for them.