The Impact of Kidney Transplant on Health Related Quality of Life in Recipients with BMI > 35

Body Kidney transplant [KTx] in recipients with BMI > 35 remains controversial and has not often been studied in patients with BMI > 40. Although health related quality of life [HRQOL] is important to consider when evaluating outcomes, there is a paucity of data as to whether HRQOL is adversely affected by being obese after KTx. This ambi-directional study examined the relationship between degree of obesity, KTx outcomes and HRQOL, across BMI groups, in a racially diverse population. Methods The medical records of 227adult, KTx recipients with BMI > 30, transplanted at the University of Illinois Hospital between 1/2009 -10/2017, were retrospectively reviewed. A prospective approach was limited to 1-time administration of the Kidney Disease Quality Of Life-36 [KDQOL-36] survey to recipients who had not yet completed it after KTx. The cohort was stratified into four obese groups: BMI 30-34.9, n=74; BMI 35-39.9, n=67; BMI 40-49.9, n=67; and BMI > 50 n=19. Data was compared across racial and BMI groups. Cox Proportional Hazard Multivariate and logistic regression were used to identify factors associated with graft survival and patient death. Kaplan-Meier survival analysis determined patient and graft survival over time. KDQOL-36 scores were used to measure HRQOL. Results Overall, 61% were Black, 44% were female. Most received organs from living donors [n=130, 57%]. Demographics were similar across BMI groups. Mean follow up was 4.5 yrs. Patient and graft survival reached 100% at 1 year in all BMI groups and was not significantly different at 3 or 5 years. Females had a .1512 [p=0.013] increase in patient survival compared to males and race did not negatively influence survival. Diabetes mellitus [DM] pre-KTx correlated [Cor= 0.149, p=0.0334] with a 3.4% [p=0.0288] increase in death risk. Rejection [p=0.000], years of education [p=0.001] and median income [p=0.036] influenced graft survival but did not affect outcomes. Wound complications [n=9, 6%] occurred in recipients with BMI 30-39.9 who had a standard open surgical approach. KDQOL-36 component scores were at or above the US dialysis population. BMI class had no effect on HRQOL, while age > 51 [p=0.000], female gender [p=0.057] and pre KTx DM [p=0.020] significantly decreased Physical Component Scores [PCS]. Conclusion KTx outcomes for those with BMI > 35, offers graft and patient survival benefits and HRQOL above the US normative average for transplant recipients and patients on dialysis. Obesity should not be an absolute contraindication to KTx regardless of race or degree of BMI. Importantly, a history of pre-KTx DM can predict poorer recipient survival and lower PCS scores in obese recipients, suggesting a need for rigorous DM management pre and post KTx.