426.3: The Impact of Obesity and Associated Comorbidities on the Outcomes After Renal Transplantation With Living Donor vs. Deceased Donor Grafts

Abstract

Background: Obesity among kidney transplant (KT) recipients can lead to metabolic comorbidity-associated deaths. This study compares post-KT survival between obese and non-obese patients and outcomes of living donor (LD) and deceased donor (DD) grafts. Methods: Between 1/2005-5/2019, 1403 KT recipients from a single center were included in the study, 314 patients (22.4%) with obesity (BMI>30 kg/m2) in the study group, and 1089 (77.6%) in the control group (BMI≤30 kg/m2). Kaplan-Meier method was used for survival analysis and Cox regression was used to identify risk factors for graft loss and mortality. Propensity score matching analysis adjusting for age, IHD, and T2DM was performed. Results: The study group had a higher incidence of obesity related comorbidities, delayed graft function and primary non functional (p<0.001). One -, 5-, and 10-year patient survival rates were 96.0%, 87.7%, and 68.3% for the study group and 98.0%, 93.6%, and 80.5% for control group (p<0.001).The respective 1-, 5-, and 10-year graft survival rates were 91.7%, 79.7%, and 58.6% for the study group and 95.4%, 87.3%, and 71.0% for the control group (p<0.001).Subgroup analysis of graft survival, according to type of craft shows a difference in the DD (p=0.002) but not in the LD group (p=0.220). However, mortality was higher in both groups (LD, p=0.045; DD, p=0.004). Risk factors for mortality were age, T2DM, IHD, and DD, and for graft failure: IHD, BMI, donor age, re-transplant, and DD. Propensity score analysis shows odds ratios of 0.81 for graft failure and 0.93 for death in the study group (95% CI=0.55 [1.21, P=0.3] and CI=0.59 [1.46, P=0.7], respectively). Conclusions: Recipient age and metabolic comorbidities should be emphasized when evaluating patients with obesity. We suggest considering LD transplant in this population since it does not show an increased risk for graft loss.