Combined Donor-Recipient Obesity and the Risk of Graft Loss After Kidney Transplantation

As the prevalence of obesity increases globally, appreciating the effect of donor and recipient (DR) obesity on graft outcomes is of increasing importance. In a cohort of adult, kidney transplant recipients (2000-2017) identified using the SRTR, we used Cox proportional hazards models to examine the association between DR obesity pairing (body mass index (BMI) >30 kg/m), and death-censored graft loss (DCGL) or all-cause graft loss, and logistic regression to examine risk of delayed graft function (DGF) and ≤30 days graft loss. We also explored the association of DR weight mismatch (>30 kg, 10-30 kg (D>R; D<R) and <10 kg (D = R)) with each outcome, stratifying by DR obesity pairing. Relative to non-obese DR, obese DR were highest risk for all outcomes (DCGL: HR 1.26, 95% CI 1.22-1.32; all-cause graft loss: HR 1.09, 95% CI 1.06-1.12; DGF: OR 1.98, 95% CI 1.89-2.08; early graft loss: OR 1.34, 95% CI 1.19-1.51). Donor obesity modified the risk of recipient obesity and DCGL [ = 0.001] and all-cause graft loss [ < 0.001] but not DGF or early graft loss. The known association of DR weight mismatch with DCGL was attenuated when either the donor or recipient was obese. DR obesity status impacts early and late post-transplant outcomes.