Cho Eun-Young, Jeon You Hyun, Huh Kyu Ha, Hwang Seun Deuk, Min Sangil, Yang Jaeseok, Kim Myoung Soo, Seo Yu Jin, Lim Jeong-Hoon, Jung Hee-Yeon, Choi Ji-Young, Park Sun-Hee, Kim Yong-Lim, Cho Jang-Hee, Kim Chan-Duck
Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
Department of Transplantation Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
BMC Nephrol. 2025 Jul 29;26(1):423. doi: 10.1186/s12882-025-04359-x.
The prevalence of obesity is steadily increasing in patients with end-stage kidney disease. However, it is still debatable whether obesity affects outcomes after kidney transplantation. This study evaluated the relationship between pretransplant obesity, defined as a body mass index (BMI) ≥ 25 kg/m, and posttransplant outcomes in Korean kidney transplant recipients (KTRs).
We investigated prospective nationwide cohort data from the Korean Organ Transplantation Registry (KOTRY) from 2014 to 2021. KTRs were categorized into 4 groups based on pretransplant BMI: underweight (< 18.5), normal weight (18.5-22.9), overweight (23-24.9), and obesity (≥ 25). Posttransplant outcomes, including death-censored allograft loss, cardiovascular events, and all-cause mortality, were compared using Kaplan-Meier curves with the log-rank test. Cox proportional hazard regression analysis was employed to assess associations between BMI and posttransplant outcomes.
A total of 9,130 KTRs were finally analyzed. The mean age was 49.9 ± 11.6 and 60.2% of KTRs were male. The prevalence of obesity in KTRs was 28.6% and continued to increase (24.8% in 2014 to 32.5% in 2021). Obese KTRs were characterized by male predominance, shorter dialysis vintage, and more diabetes as primary kidney disease. Kaplan-Meier curve showed a significant difference in death-censored allograft loss among BMI groups (P = 0.007). Obesity (BMI ≥ 25 kg/m²) was as an independent risk factor for death-censored allograft loss (adjusted hazard ratio 1.511, 95% confidence interval 1.063-2.148, P = 0.021), but not for cardiovascular events or mortality.
Our study evaluated BMI across a spectrum of categories, suggesting that obesity is an independent risk factor for graft survival in KTRs. Risk stratification using BMI and strategies to prevent obesity should be considered in the preparation for kidney transplantation.
Not applicable.
终末期肾病患者的肥胖患病率正在稳步上升。然而，肥胖是否会影响肾移植后的结局仍存在争议。本研究评估了移植前肥胖（定义为体重指数[BMI]≥25kg/m²）与韩国肾移植受者（KTRs）移植后结局之间的关系。
我们调查了韩国器官移植登记处（KOTRY）2014年至2021年的前瞻性全国队列数据。根据移植前BMI将KTRs分为4组：体重过轻（<18.5）、正常体重（18.5-22.9）、超重（23-24.9）和肥胖（≥25）。使用Kaplan-Meier曲线和对数秩检验比较移植后结局，包括死亡删失的移植肾丢失、心血管事件和全因死亡率。采用Cox比例风险回归分析评估BMI与移植后结局之间的关联。
最终分析了9130例KTRs。平均年龄为49.9±11.6岁，60.2%的KTRs为男性。KTRs中肥胖的患病率为28.6%，且持续上升（2014年为24.8%，2021年为32.5%）。肥胖的KTRs以男性为主、透析时间较短以及更多糖尿病作为原发性肾病为特征。Kaplan-Meier曲线显示BMI组间死亡删失的移植肾丢失存在显著差异（P=0.007）。肥胖（BMI≥25kg/m²）是死亡删失的移植肾丢失的独立危险因素（调整后的风险比1.511，95%置信区间1.063-2.148，P=0.021），但不是心血管事件或死亡率的危险因素。
我们的研究评估了一系列BMI类别，表明肥胖是KTRs移植肾存活的独立危险因素。在肾移植准备过程中应考虑使用BMI进行风险分层以及预防肥胖的策略。
不适用。
