LAUSR

Background: Body Mass Index (BMI) is often used a surrogate marker of suitability for kidney transplantation. Some centers in Australia will limit patients being waitlisted for transplantation unless there BMI is less than 35. With BMI increasing in the general population and the ever increasing diabetic and obesity related health issues such as renal failure, transplantation on patients with high BMI is inevitable. Methods: We used local and national data to retrospectively evaluate the outcomes of all patients that received a kidney transplant with a BMI > 35 pre-transplantation. Recipients that had undergone transplantation in the period of 2009-2018 with a BMI of 35 were compared against patients with a BMI of 31-34 and of BMI < 30. Graft function and overall survival was analysed using a univariate COX PH model and demonstrated with Kaplein-Meier curves, along with individual assessment of specific surgical complications. Results: Of the 1222 renal transplants that were performed 102 patients had a BMI >35 with the overall survival and graft survival comparable to the BMI < 30 group. Median follow-up was 15.2 years. There was a slightly higher wound complication rate when compared to patients with a BMI < 30 (0.5% versus < 0.5%) P< 0.05. Cox model analysis showed no significant increase in hazards for BMI > 35 compared to BMI <30, but patients with BMI 31-34 had both increased hazards for both graft loss and death. Significant complications in the BMI >35 included a single mortality caused by a PE.