M. Gunder1, C. Biefeld1, V. Dioguardi1, K. N. Lau1, A. Di Carlo1, S. Karhadkar1 1Temple University,Surgery,Philadelphia, PA, USA
Introduction
Prior studies have demonstrated a relationship between obesity and increased risk for morbidity and mortality after kidney transplantation. Therefore, patients with a high body mass index (BMI) can be denied listing status, or have longer waitlist times. The relationship between obesity and simultaneous heart-kidney transplant (SHKT) outcomes has not been studied.
Methods
A retrospective analysis of all patients listed in the United Network for Organ Sharing database undergoing SHKT between 2006-2018 was performed. Patients were grouped into categories based on BMI, including underweight (BMI 16.00-18.49), normal (BMI 18.50-24.99), overweight (BMI 25.00-29.99), or obese (BMI 30.00-60.00). Data was collected on patient outcomes including length of stay, incidence of delayed graft failure, heart or kidney allograft failure, resumption of maintenance dialysis, and overall patient survival. Fisher exact test or ANOVA analysis were performed to assess correlation between BMI and SHKT outcomes. Kaplan Meier analysis was used to project patient and allograft survival across BMI groups.
Results
A total of 1054 simultaneous heart-kidney transplants were performed during the time period studied. 33 recipients were underweight, 375 were normal weight, 400 were overweight, and 246 were obese. The overall mean survival for all patients was 3238 days. Overall rate of kidney graft failure was 8.8% and of heart graft failure was 5.2%. Interestingly, a higher BMI was not associated with an increased length of stay (p=0.712), incidence of DGF (p=0.786), incidence of kidney (p=0.581) or heart (p=0.734) graft failure, or decreased overall survival (p=0.160).
Conclusion
Obesity does not correlate with adverse outcomes after simultaneous heart-kidney transplantation. A similar rate of kidney allograft failure, heart allograft failure, and patient mortality was seen in all groups. A higher BMI should not preclude potential recipients from being listed for SHKT.