Abstract
Background
Body mass index of living kidney donors has increased substantially. Determining candidacy
for live kidney donation among obese individuals is challenging because many donation-related
risks among this subgroup remain unquantified, including even basic postdonation mortality.
Methods
We used data from the Scientific Registry of Transplant Recipients linked to data
from the Centers for Medicare and Medicaid Services to study long-term mortality risk
associated with being obese at the time of kidney donation among 119,769 live kidney
donors (1987–2013). Donors were followed for a maximum of 20 years (interquartile
range 6.0–16.0). Cox proportional hazards estimated the risk of postdonation mortality
by obesity status at donation. Multiple imputation accounted for missing obesity data.
Results
Obese (body mass index ≥ 30) living kidney donors were more likely male, African American,
and had higher blood pressure. The estimated risk of mortality 20 years after donation
was 304.3/10,000 for obese and 208.9/10,000 for nonobese living kidney donors. Adjusting
for age, sex, race/ethnicity, blood pressure, baseline estimated glomerular filtration
rate, relationship to recipient, smoking, and year of donation, obese living kidney
donors had a 30% increased risk of long-term mortality compared with their nonobese
counterparts (adjusted hazard ratio: 1.32, 95% CI: 1.09–1.60, P = .006). The impact of obesity on mortality risk did not differ significantly by
sex, race or ethnicity, biologic relationship, baseline estimated glomerular filtration
rate, or among donors who did and did not develop postdonation kidney failure.
Conclusion
These findings may help to inform selection criteria and discussions with obese persons
considering living kidney donation.
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Article info
Publication history
Published online: May 06, 2019
Accepted:
March 19,
2019
Footnotes
Supported by National Institutes of Health grant numbers K23-DK103918 (Jayme Locke), R01-DK113980 (Jayme Locke), and K01DK-K01-DK101677 (Allan Massie); K24-DK101828 (Dorry Segev) and he American Society of Transplantation Clinical Scientist Faculty Development Grant (Jayme Locke).
J.E.L. and D.L.S. designed the study. R.D.R., P.A.M., A.B.M., and J.J.S. performed the data analyses. J.E.L. drafted and revised the manuscript. R.D.R., P.A.M., A.B.M., D.S., V.K., B.A.S., M.N.M., J.J.S., C.E..L, and D.L.S. assisted with interpretation of results and critically revised the manuscript. All authors approved the final version of the manuscript.
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