Outcomes of Underweight, Overweight, and Obese Pediatric Kidney Transplant Recipients

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 2018 Aug 24

PMID 30136105

Citations 20

Authors

Kiranjot Kaur

Daniel Jun

Elliot Grodstein

Pamela Singer

Laura Castellanos

Lewis Teperman

Ernesto Molmenti

Ahmed Fahmy

Rachel Frank

Lulette Infante

Christine B Sethna

Affiliations

Soon will be listed here.

Abstract

Background: Obesity is a risk factor for poor transplant outcomes in the adult population. The effect of pre-transplant weight on pediatric kidney transplantation is conflicting in the existing literature.

Methods: Data was collected from the Organ Procurement and Transplantation Network (OPTN) database on recipients aged 2-21 years who received a kidney-only transplant from 1987 to 2017. Recipients were categorized into underweight, normal, overweight, and obese cohorts. Using adjusted regression models, the relationship between recipient weight and various graft outcomes (delayed graft function [DGF], acute rejection, prolonged hospitalization, graft failure, mortality) was examined.

Results: 18,261 transplant recipients (mean age 14.1 ± 5.5 years) were included, of which 8.7% were underweight, 14.8% were overweight, and 15% were obese. Obesity was associated with greater odds of DGF (OR 1.3 95% CI 1.13-1.49, p < 0.001), acute rejection (OR 1.23 95% CI 1.06-1.43, p < 0.01), and prolonged hospitalization (OR 1.35 95% CI 1.17-1.54, p < 0.001) as well as greater hazard of graft failure (HR 1.13 95% CI 1.05-1.22, p = 0.001) and mortality (HR 1.19 95% CI 1.05-1.35, p < 0.01). The overweight cohort had an increased risk of graft failure (HR 1.08 95% CI 1.001-1.16, p = 0.048) and increased odds of DGF (OR 1.2 95% CI 1.04-1.38, p = 0.01) and acute rejection (OR 1.18 95% CI 1.01-1.38, p = 0.04). When stratified by age group, the increased risk was realized among younger and older age groups for obese and overweight. Underweight had lower risk of 1-year graft failure (HR 0.82 95% CI 0.71-0.94, p < 0.01), overall graft failure in the 13-17-yr. age group (HR 0.84 95% CI 0.72-0.99, p = 0.03) and acute rejection in the 2-5-yr. age group (OR 0.24 95% CI 0.09-0.66, p < 0.01).

Conclusion: Pre-transplant weight status and age impact pediatric kidney transplant outcomes. Recipient underweight status seems to be protective against adverse outcomes while overweight and obesity may lead to poorer graft and patient outcomes.

Citing Articles

Identifying Risk Factors for Graft Failure due to Chronic Rejection < 15 Years Post-Transplant in Pediatric Kidney Transplants Using Random Forest Machine-Learning Techniques.

Suh H Pediatr Transplant. 2025; 29(2):e70043.

PMID: 39981772 PMC: 11843590. DOI: 10.1111/petr.70043.

Rapid Weight Gain After Pediatric Kidney Transplant and Development of Cardiometabolic Risk Factors Among Children Enrolled in the North American Pediatric Renal Trials and Collaborative Studies Cohort.

Twichell S, Hunt E, Ciurea R, Somers M Pediatr Transplant. 2024; 29(1):e70005.

PMID: 39729540 PMC: 11677067. DOI: 10.1111/petr.70005.

Weight of evidence: reevaluating BMI criteria as a barrier for kidney transplantation in children.

Theodorou D, Shenoy M Pediatr Nephrol. 2024; 40(3):599-603.

PMID: 39565420 DOI: 10.1007/s00467-024-06602-3.

Multidisciplinary approach to optimizing long-term outcomes in pediatric kidney transplant recipients: multifaceted needs, risk assessment strategies, and potential interventions.

Gu L, Gross A, Kizilbash S Pediatr Nephrol. 2024; 40(3):661-673.

PMID: 39356298 DOI: 10.1007/s00467-024-06519-x.

Body mass index in pediatric kidney transplant selection criteria.

Engen R, Sgambat K, Verghese P, Jain A, Smith J, Twombley K Pediatr Nephrol. 2024; 39(11):3333-3338.

PMID: 39008117 DOI: 10.1007/s00467-024-06453-y.

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