Too fat for transplant? The impact of recipient BMI on pancreas transplant outcomes

ABSTRACT NUMBER: NESTAC_12

 

AUTHORS
Ruth V Owen1, Emily R Thompson1, Samuel J Tingle1, Ibrahim K Ibrahim1, L Bates1, Derek M Manas2, Steve A White2, Colin H Wilson1, 2

AFFILIATIONS

1  NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, Newcastle University, Newcastle upon Tyne, NE2 4HH

2 Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, NE7 7DN

CORRESPONDING AUTHOR CONTACT EMAIL
ku.ca.eltsacwen@4newo.r

MAIN ABSTRACT TEXT

Currently a recipient Body Mass Index (BMI) greater than 30kg/m2 is seen as a contraindication for pancreas transplantation. In the UK 26% of the population are obese meaning many patients could find themselves excluded from this treatment. This study investigates the true impact of recipient BMI on graft survival after transplantation.

Retrospective data on all UK pancreas transplants from 1994-2016 were obtained from the NHSBT UK Transplant Registry, n=1452. Graft survival analysis was conducted using Kaplan-Meier plots and a Cox regression model.

Mean recipient BMI was 24.8kg/m2 (±2.4), with 507 overweight and 146 obese recipients receiving transplants. 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). Univariate analysis was then conducted. No statistically significant difference was seen between the higher BMI categories compared with normal (18.5-24.9kg/m2).

The data was stratified further using modified BMI categories. Recipients with a BMI between 29-30.9 had a significant reduction in graft survival (n=135, p<0.01). Unexpectedly, recipients with a BMI between 31-32.9 (n=58) had an improvement in graft survival, this trend was not significant. Recipients with a BMI of 33-34.9 (n=17) or BMI of >35 (n=8) demonstrated a non-significant trend towards worse graft survival.

Analysis has proved difficult to delineate a cut-off value that precludes pancreas transplantation. This is likely due to selection bias inherent in this retrospective cohort and the small numbers in the truly obese cohorts. Therefore, when determining a patient’s eligibility for pancreas transplant, this analysis suggests obese recipients could be considered.