BMI impacts allograft outcomes in kidney transplant for recipients with type 2 diabetes

Amarpali Brar

BOSTON — For transplant recipients with type 2 diabetes, delayed graft function was more common in those with higher BMIs and allograft survival was lowest in those categorized as obese or underweight, according to research presented at the American Transplant Congress.

“As we all know, diabetes is a disease that is increasing in prevalence worldwide and is one of the main causes of kidney disease,” Amarpali Brar, MD, transplant nephrologist at SUNY Downstate Medical Center, said in a presentation. “Almost 40% of patients with end-stage renal disease are diabetic. The objective of this study was to look at renal allograft and patient survival outcomes in type 2 diabetic renal transplant recipients stratified by BMI. We found the extremes of BMI were associated with worse outcomes.”

For the study, researchers considered all patients with type 2 diabetes who had a solitary kidney transplant performed between 2008 and 2017, including 10,616 living donor transplants and 30,992 deceased donor transplants.

Researchers noted the proportion of transplant recipients with both type 2 diabetes and obesity increased from 16.8% between 1987 and 1992 to 49.6% between 2013 and 2017.

Patients were first categorized as having normal BMI (15.7%), being underweight (0.48%) or being overweight (34.2%). Overweight patients were further divided into having class I obesity (BMI, 30 kg/m²to 34.9 kg/m²), class II obesity (BMI, 35 kg/m²to 39.9 kg/m²) or class III obesity (BMI greater than 40 kg/m²). Graft outcomes were analyzed according to BMI subgroups.

For both living and deceased donor transplants, researchers observed delayed graft function in 23.4% of recipients who were underweight, in 28.2% of recipients with normal weight and in 30.7% of recipients who were overweight. Rates of delayed graft function were highest in those with class III obesity (43.7%) compared with class II obesity (36.6%) and class I obesity (34.3%).

For deceased donor transplant only, researchers found graft survival at 1 year, 3 years and 5 years was lowest in those who were underweight followed by those with class III obesity. – by Melissa J. Webb

Reference:

Brar A, et al. Abstract 327. Presented at: American Transplant Congress. June 1-5, 2019; Boston.

Disclosure: Brar reports no relevant financial disclosures.