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Nephrol Dial Transplant. 2015 Aug;30(8):1403-11. doi: 10.1093/ndt/gfv214. Epub 2015 Jun 4.

Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis.

Author information

  • 1Regional Nephrology Unit, Belfast City Hospital, Belfast, UK.
  • 2Centre for Public Health, Queen's University Belfast, Belfast, UK.
  • 3Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
  • 4Vascular Surgery and Organ Transplant Unit, University of Catania, Catania, Italy.
  • 5Department of Urology and Renal Transplantation, University Hospital, Coimbra, Portugal.
  • 6Department of Surgery, University of Louisville, Louisville, KY, USA.
  • 7Department of Nephrology, Leiden University Medical Centre, Leiden, The Netherlands.
  • 8Department of Internal Medicine, Wayne State University, Detroit, MI, USA.



The prevalence of obesity is increasing globally and is associated with chronic kidney disease and premature mortality. However, the impact of recipient obesity on kidney transplant outcomes remains unclear. This study aimed to investigate the association between recipient obesity and mortality, death-censored graft loss and delayed graft function (DGF) following kidney transplantation.


A systematic review and meta-analysis was conducted using Medline, Embase and the Cochrane Library. Observational studies or randomized controlled trials investigating the association between recipient obesity at transplantation and mortality, death-censored graft loss and DGF were included. Obesity was defined as a body mass index (BMI) of ≥30 kg/m(2). Obese recipients were compared with those with a normal BMI (18.5-24.9 kg/m(2)). Pooled estimates of hazard ratios (HRs) for patient mortality or death-censored graft loss and odds ratios (ORs) for DGF were calculated.


Seventeen studies including 138 081 patients were analysed. After adjustment, there was no significant difference in mortality risk in obese recipients [HR = 1.24, 95% confidence interval (CI) = 0.90-1.70, studies = 5, n = 83 416]. However, obesity was associated with an increased risk of death-censored graft loss (HR = 1.06, 95% CI = 1.01-1.12, studies = 5, n = 83 416) and an increased likelihood of DGF (OR = 1.68, 95% CI = 1.39-2.03, studies = 4, n = 28 847).


Despite having a much higher likelihood of DGF, obese transplant recipients have only a slightly increased risk of graft loss and experience similar survival to recipients with normal BMI.


graft survival; kidney transplantation; mortality; obesity

[PubMed - indexed for MEDLINE]
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