Investigating the controversial link between pediatric obesity and graft survival in kidney transplantation

doi:10.5527/wjn.v14.i2.101961

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World Journal of Nephrology

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2220-6124

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

World J Nephrol. Jun 25, 2025; 14(2): 101961
Published online Jun 25, 2025. doi: 10.5527/wjn.v14.i2.101961

Table 1 Recipient and donor characteristics of pediatric kidney transplants separated by body mass index class, n (%)

Characteristic	Underweight (< 5^th)	Healthy weight (5^th-85^th)	Overweight (85^th-95^th)	Class 1 obese (95^th-120%95^th)	Class 2 obese (120%-140%95^th)	Class 3 obese (> 140%95^th)
Transplant variables
Transplants	2040 (8.8)	14361 (62.2)	3142 (13.6)	2588 (11.2)	725 (3.1)	225 (1.0)
Living donor type	864 (42.4)^c^,^d^,^e^,^f	6143 (42.8)^c^,^d^,^e^,^f	1220 (38.8)^a^,^b^,^e	1013 (39.1)^a^,^b^,^e	249 (34.3)^a^,^b^,^c^,^d^,^f	80 (35.6)^a^,^b^,^e
Mean cold ischemia time (SE) (hours)	11.0 (0.25)^b^,^c^,^d	10.2 (0.09)^a^,^e^,^f	10.9 (0.19)^a^,^e^,^f	10.5 (0.39)^a^,^e^,^f	11.6 (0.82)^b^,^c^,^d	13.1^b^,^c^,^d
Mean distance from transplant center (SE) (nmi)	93.6 (6.0)	87.9 (2.2)	90.8 (4.5)	89.4 (4.7)	96.0 (19.0)	115.2
Mean HLA mismatches (SE)	3.53 (0.03)	3.61 (0.01)	3.70 (0.03)	3.73 (0.03)	3.78 (0.06)	3.65 (0.10)
DGF	186 (9.1)	1174 (8.2)	267 (8.5)	248 (9.6)	61 (8.4)	22 (9.8)
Transplant era
1987-1999	851 (41.0)	4240 (29.5)	828 (26.4)	680 (26.0)	191 (26.3)	100 (44.4)
2000-2003	208 (10.2)	1577 (11.0)	402 (12.8)	309 (11.9)	101 (13.9)	35 (15.6)
2004-2007	201 (9.9)	1959 (13.6)	413 (13.1)	368 (14.2)	119 (16.4)	26 (11.6)
2008-2011	218 (10.7)	1883 (13.1)	422 (13.4)	345 (13.3)	86 (11.9)	19 (8.4)
2012-2015	194 (9.5)	1770 (12.3)	401 (12.8)	331 (12.8)	82 (11.3)	17 (7.6)
2016-2019	234 (11.5)	1813 (12.6)	413 (13.1)	333 (12.9)	80 (11.0)	16 (7.1)
2020-2022	134 (6.6)	1117 (7.8)	263 (8.4)	222 (8.6)	66 (9.1)	12 (5.3)
Donor variables
Mean age (SE) years	29.5 (0.29)^b^,^c^,^d^,^e^,^f	29.4 (0.10)^a^,^c^,^d^,^e^,^f	28.8 (0.22)^a^,^b^,^e^,^f	27.6 (0.23)^a^,^b^,^e^,^f	28.6 (0.44)^a^,^b^,^c^,^d	27.2 (0.84)^a^,^b^,^c^,^d
Male natal sex	1164 (57.1)	8065 (56.2)	1760 (56.0)	1423 (55.0)	416 (57.4)	129 (57.3)
Race or ethnicity
White	1310 (64.2)^b^,^c^,^c^,^d^,^f	9634 (67.1)^a^,^c^,^d^,^e^,^f	2082 (66.3)^a^,^b^,^e^,^f	1728 (66.8)^a^,^b^,^e^,^f	1310 (64.2)^a^,^b^,^c^,^d^,^f	9634 (67.1)^a^,^b^,^c^,^d^,^e
Black	259 (12.7)	1681 (11.7)	390 (12.4)	334 (12.9)	259 (12.7)	1681 (11.7)
Hispanic	379 (18.6)	2590 (18.0)	575 (18.3)	444 (17.2)	379 (18.6)	2590 (18.0)
Asian	62 (3.0)	276 (1.9)	63 (2.0%)	49 (1.9)	62 (3)	276 (1.9)
Multiracial/other	30 (1.4)	180 (1.2)	32 (1.0)	33 (1.3)	30 (1.4)	180 (1.2)
Mean donor BMI (SE)	24.9 (0.139)^e^,^f	25.3 (0.050)^e^,^f	25.4 (0.107)^e^,^f	25.3 (0.121)^e^,^f	26.1 (0.246)^a^,^b^,^c^,^d^,^f	24.6 (0.462)^a^,^b^,^c^,^d^,^e
Mean KDPI (SE)	177 (0.005)	0.167 (0.002)	0.170 (0.004)	0.171 (0.004)	0.168 (0.007)	0.172 (0.013)
Recipient variables
Median age (75^th-25^th)	12.9 (0.09)^c^,^d^,^e^,^f	11.9 (0.04)^c^,^d^,^e^,^f	10.7 (0.09)^a^,^b	9.23 (0.11)^a^,^b	11.1 (0.19)^a^,^b	10.3 (0.33)^a^,^b
Male natal sex	1188 (58.2)^d^,^e^,^f	8254 (57.5)^d^,^e^,^f	1827 (58.1)^d^,^e^,^f	1646 (63.6)^a^,^b^,^c	448 (61.8)^a^,^b^,^c	150 (66.7)^a^,^b^,^c
Race or ethnicity
White	1106 (54.2)^c^,^d^,^e^,^f	7837 (54.6)^c^,^d^,^e^,^f	1634 (52.0)^a^,^b^,^e	1347 (52.0)^a^,^b^,^e	356 (49.1)^a^,^b^,^c^,^d^,^f	119 (52.9)^a^,^b^,^e
Black	400 (19.6)	2566 (17.9)	598 (19.0)	479 (18.5)	149 (20.6)	59 (26.2)
Hispanic	394 (19.3)	3209 (22.3)	747 (23.8)	635 (24.5)	182 (25.1)	37 (16.4)
Asian	108 (5.3)	467 (3.3)	76 (2.4)	66 (2.6)	17 (2.3)	3 (1.3)
Multiracial/other	32 (1.5)	282 (1.9)	87 (2.9)	61 (2.4)	21 (2.9)	7 (3)

^aP < 0.05 vs underweight.

^bP < 0.05 vs healthy weight.

^cP < 0.05 vs overweight.

^dP < 0.05 vs obese I.

^eP < 0.05 vs obese II.

^fP < 0.05 vs obese III.

DGF: Delayed graft function; KDPI: Kidney Donor Profile Index.

Table 2 Patient survival and graft survival log-rank testing between the different body mass index categories

Graft survival pairwise log rank testing	Underweight (< 5^th)	Healthy weight (5^th-85^th)	Overweight (85^th-95^th)	Class 1 obese (95^th-120%95^th)	Class 2 obese (120%-140%95^th)	Class 3 obese (> 140%95^th)
Underweight (< 5^th)		0.279	0.953	0.469	0.119	0.099
Healthy weight (5^th-85^th)	0.279		0.246	0.796	0.013	0.022
Overweight (85^th-95^th)	0.953	0.246		0.448	0.099	0.055
Class 1 obese (95^th-120%95^th)	0.469	0.796	0.448		0.033	0.033
Class 2 obese (120%-140%95^th)	0.119	0.013	0.099	0.033		0.540
Class 3 Obese (> 140%95^th)	0.099	0.022	0.055	0.033	0.540
Patient survival pairwise log rank testing
Underweight (< 5^th)		0.007	0.026	0.316	0.779	0.013
Healthy Weight (5^th-85^th)	0.007		0.845	0.179	0.03	< 0.001
Overweight (85^th-95^th)	0.026	0.845		0.301	0.039	< 0.001
Class 1 obese (95^th-120%95^th)	0.316	0.179	0.301		0.235	0.002
Class 2 obese (120%-140%95^th)	0.779	0.03	0.039	0.235		0.063
Class 3 obese (> 140%95^th)	0.013	< 0.001	< 0.001	0.002	0.063

Table 3 Median graft survival and median patient survival between the different body mass index categories

	Underweight (< 5^th)	Healthy weight (5^th-85^th)	Overweight (85^th-95^th)	Class 1 obese (95^th-120%95^th)	Class 2 obese (120%-140%95^th)	Class 3 obese (> 140%95^th)
Median graft survival (95%CI) (years)	11.6 (10.9-12.3)^b^,^c^,^d^,^e^,^f	12.2 (11.9–12.4)^a^,^e	11.9 (11.4–12.4)^a^,^e	12.0 (11.4–12.6)^a^,^e	9.7 (8.7–10.6)^a^,^e	11.8 (10.5–13.0)^a^,^b^,^c^,^d^,^e
1-year graft survival rate	92.2%^f	93.1%^f	92.6%^f	92.0%^f	92.7%^f	88.7%^a^,^b^,^c^,^d^,^e
5-year graft survival rate	71.3%^b^,^c^,^d	73.8%^a^,^e^,^f	73.1%^a^,^e^,^f	73.6%^a^,^e^,^f	67.8%^b^,^c^,^d	68.3%^b^,^c^,^d
10-year graft survival rate	45.0%^b^,^c^,^d^,^f	46.8%^a^,^e	47.0%^a^,^e	49.5%^a^,^e	40.7%^b^,^c^,^d^,^f	48.7%^a^,^e
Median patient survival (95%CI) (years)	26.9 (24.4-29.4)^f	26.0 (24.7-27.2)^f	24.8 (23.6–25.9)^f	24.8 (22.9-26.7)^f		23.1 (21.1-25.0)^a^,^b^,^c^,^d
1-year graft survival rate	92.2%	93.1%	92.6%	92.0%	92.7%	88.7%
5-year patient survival rate	93.6%^c^,^d	92.5%^c^,^d	95.6%^a^,^b^,^e^,^f	94.6%^a^,^b^,^e^,^f	92.6%^c^,^d	91.3%^c^,^d
10-year patient survival rate	81.3%^b^,^c^,^d	85.5%^a^,^e^,^f	86.7%^a^,^e^,^f	86.1%^a^,^e^,^f	78.9%^b^,^c^,^d	79.9%^b^,^c^,^d