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Too Fat for Transplant? The Impact of Recipient BMI on Pancreas Transplant Outcomes

Lookup NU author(s): Dr Ruth Owen, Dr Emily Thompson, Dr Sam Tingle, Dr Ibrahim Ibrahim, Professor Derek Manas, Steven White, Colin Wilson

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Abstract

Background: In many transplant centres, a recipient Body Mass Index (BMI) >30kg/m2would be considered a contraindication for pancreas transplantation. This study aims to investigate the impact of recipient BMI on graft outcomes after pancreas transplantation.Methods: Retrospective data on all UK solid organ pancreas transplants from 1994 - 2016 were obtained from the NHSBT UK Transplant Registry, n=2618. Cases missing BMI data were excluded, resulting in a final cohort of n=1452. Graft and patient survival analysis were conducted using Kaplan-Meier plots and Cox regression models.Results: The mean recipient BMI was 24.8kg/m2 (±2.4). There were 507 overweight (BMI 25-29.9) and 146 obese (>30) recipients receiving pancreas transplants. Univariate analysis showed no statistically significant difference between overweight BMI categories compared with normal BMI (18.5-24.9kg/m2). Multivariate analysis revealed increasing recipient BMI had a significant impact on graft survival (p=0.03, HR 1.04, 95%CI 1.00, 1.08). Receiver Operating Characteristic (ROC) curve analyses revealed no value of BMI that provided both specific and sensitive discrimination between death and survival of both grafts or patients. Recipients on dialysis with a BMI >30kg/m2 had a statistically significant decrease in both graft (p=0.002) and patient survival (p=0.015).Conclusions: Analysis of available UK Pancreas data has shown recipient BMI is an independent risk factor for patient survival after transplantation. However, we have been unable to define a specific cut-off value above which patients have poorer outcomes. Obese patients on haemodialysis had the poorest graft survival and preemptive transplantation may be beneficial in this cohort.


Publication metadata

Author(s): Owen RV, Thompson ER, Tingle SJ, Ibrahim IK, Manas DM, White SA, Wilson CH

Publication type: Article

Publication status: Published

Journal: Transplantation

Year: 2020

Pages: epub ahead of print

Online publication date: 28/05/2020

Acceptance date: 02/04/2016

ISSN (print): 0041-1337

ISSN (electronic): 1534-6080

Publisher: Lippincott, Williams & Wilkins

URL: https://doi.org/10.1097/TP.0000000000003334

DOI: 10.1097/TP.0000000000003334


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