SAT-092 IS BODY MASS INDEX A SIGNIFICANT INDEPENDENT RISK FACTOR FOR GRAFT FAILURE AND PATIENT DEATH IN THE MODERN IMMUNOSUPPRESSION ERA?

Abstract

Previous studies have shown that kidney transplant recipients with a high body mass index (BMI) have an inferior graft and patient outcomes compared to patients with a lower BMI. We used data from the United Network for Organ Sharing (UNOS) to determine whether obesity affects patient and graft outcomes following kidney transplantation in the modern immunosuppressive era. The study sample consisted of 69,749 recipients from 1987-1999 and 197,986 recipients from 2000-2016. We created multivariate models to evaluate the independent effect of BMI on graft and patient outcomes, adjusting for factors known to affect graft success and patient survival. Cox regression modeling hazard ratios showed that the relative risk for graft loss, patient death and patient death with a functioning graft in the modern immunosuppressive era (2000-2016) has significantly decreased compared to the earlier era (1987-1999) especially for living kidney transplant recipients. Figure 1. The distribution of pretransplantation BMI according to era. Figure 2. Cox proportional hazards model for graft loss and patient death with graft function according to period by categorized BMI in living kidney transplantation.(A: Relative risk for graft loss in year 1987-1999, B: Relative risk for graft loss in year 2000-2016, C: Relative risk for patient death with graft function in year 1987-1999, D: Relative risk for patient death with graft function in year 2000-2016) The relative risk of graft failure and patient death with increasing BMI has appreciably decreased in the modern immunosuppressive era, especially for living donor transplant recipients. Withholding transplantation from patients with higher BMIs may no longer be justifiable on grounds of worse clinical outcomes.