Recipient obesity and outcomes after kidney transplantation: a systematic review and meta-analysis.
Hill CJ, Courtney AE, et al.Nephrology Dialysis Transplantation 2015; 30(8): 1403-1411.
Aims
To investigate the association between recipient obesity and mortality, death-censored graft loss and delayed graft function (DGF) following kidney transplantation.
Interventions
A systematic review and meta-analysis was conducted and observational studies or randomized controlled trials investigating the association between recipient obesity at transplantation and mortality, death-censored graft loss and DGF were included.
Participants
17 studies including 138,081 patients were analysed.
Outcomes
Outcomes measured were mortality risk, graft loss, and DGF.
Follow-up
Not applicable
CET Conclusions
This systematic review and meta-analysis is directed at 17 observational studies of obesity at the time of transplantation and includes approximately 140,000 patients. Obesity in the recipient was defined as a BMI of equal or greater than 30 kg/m2. The results show a significant association between obesity and delayed graft function, and a slight but significant increased risk of death censored graft loss but no increase in patient mortality compared to recipients with a normal BMI (18.5 – 24.9). The authors point out the limitations of this study in great detail, particularly bearing in mind that only observational studies could be used, but they have handled this well. Their conclusions are that despite there being a much higher likelihood of delayed graft function, obese transplant recipients have only a slight increased risk of graft loss and a similar survival to recipients with normal BMI. It should be noted that their study has not presented an analysis of quality of the observational studies used and heterogeneity in the meta-analysis is high as might be expected.
Quality notes
Quality Assessment not appropriate
Trial registration
None